Provider Demographics
NPI:1134242605
Name:COSTON, RITA ROTH (NP)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:ROTH
Last Name:COSTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 E PRESIDIO PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1120
Mailing Address - Country:US
Mailing Address - Phone:520-881-0464
Mailing Address - Fax:
Practice Address - Street 1:6369 E TANQUE VERDE RD STE 220
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3834
Practice Address - Country:US
Practice Address - Phone:520-298-8388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN031988363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health