Provider Demographics
NPI:1013258391
Name:COSTA, KRISTINA ANN (RN)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANN
Last Name:COSTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:ANN
Other - Last Name:NIELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-795-3619
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:625 HILBY AVE
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-5720
Practice Address - Country:US
Practice Address - Phone:831-394-1691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN821307163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse