Provider Demographics
NPI:1982366977
Name:COSTA, ELISE ANN
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:ANN
Last Name:COSTA
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 1:10451 ULMERTON RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3530
Mailing Address - Country:US
Mailing Address - Phone:727-586-2400
Mailing Address - Fax:
Practice Address - Street 1:10451 ULMERTON RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3530
Practice Address - Country:US
Practice Address - Phone:727-586-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5558237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist