Provider Demographics
NPI:1285967976
Name:COSTON, TAMMY MARIE
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:MARIE
Last Name:COSTON
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 1:2651 SANITARIUM RD
Mailing Address - Street 2:PO BOX 58
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432-9706
Mailing Address - Country:US
Mailing Address - Phone:315-462-5242
Mailing Address - Fax:315-462-5242
Practice Address - Street 1:2651 SANITARIUM RD
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-9706
Practice Address - Country:US
Practice Address - Phone:315-462-5242
Practice Address - Fax:315-462-5242
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10 290823164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse