Provider Demographics
NPI:1700427531
Name:COSTA, LAURIE ANNE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANNE
Last Name:COSTA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2382 FARADAY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7219
Mailing Address - Country:US
Mailing Address - Phone:858-209-9871
Mailing Address - Fax:858-939-1595
Practice Address - Street 1:2382 FARADAY AVE STE 100
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7219
Practice Address - Country:US
Practice Address - Phone:858-209-9871
Practice Address - Fax:858-939-1595
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012686363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health