Provider Demographics
NPI:1912482282
Name:COSTA, CELINA (PA-C)
Entity Type:Individual
Prefix:
First Name:CELINA
Middle Name:
Last Name:COSTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-5842
Mailing Address - Country:US
Mailing Address - Phone:954-423-9234
Mailing Address - Fax:954-423-9231
Practice Address - Street 1:2337 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5842
Practice Address - Country:US
Practice Address - Phone:954-423-9234
Practice Address - Fax:954-423-9231
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00496700207Q00000X
FLPA9112376363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine