Provider Demographics
NPI:1194910760
Name:D'COSTA, AGATHA L (CRNP)
Entity type:Individual
Prefix:
First Name:AGATHA
Middle Name:L
Last Name:D'COSTA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 GEORGIA AVENUE NW
Mailing Address - Street 2:WRAMC ATTENTION MCHL-MAO-C
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20307-5001
Mailing Address - Country:US
Mailing Address - Phone:202-782-3366
Mailing Address - Fax:
Practice Address - Street 1:6900 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0003
Practice Address - Country:US
Practice Address - Phone:202-782-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN968444363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health