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CARYN LEE JACKSON-COSTELLO
Personal Care Attendant >> Technician >> Nursing Service Related ProvidersRegistrant NPI Number: 1023580545
Individual Registrant: CARYN LEE JACKSON-COSTELLO
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
229H MEDALLION BOULEVARD MADEIRA BEACH, FL 33708 US
Tel: 727-412-0569 Fax: --
Tel: 727-412-0569 Fax: --
Contact information for business:
229H MEDALLION BOULEVARD MADEIRA BEACH, FL 33708 US
Tel: 727-412-0569 Fax: --
Tel: 727-412-0569 Fax: --
Registration Information:
NPI: 1023580545
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 3747P1801X | Nursing Service Related Providers Technician Personal Care Attendant |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
