Provider Demographics
NPI:1427680263
Name:COSTALES, YOLANDA MARIA (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:MARIA
Last Name:COSTALES
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 SE 16TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-1257
Mailing Address - Country:US
Mailing Address - Phone:786-205-9605
Mailing Address - Fax:
Practice Address - Street 1:2336 SE 16TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-1257
Practice Address - Country:US
Practice Address - Phone:786-205-9605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005918363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily