Provider Demographics
NPI:1255171781
Name:COSTACHE, MARILYN
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:COSTACHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30841 KELMIN TER
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-6622
Mailing Address - Country:US
Mailing Address - Phone:305-904-9291
Mailing Address - Fax:
Practice Address - Street 1:23542 STATE ROAD 54 STE 113
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-6753
Practice Address - Country:US
Practice Address - Phone:813-214-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other