Provider Demographics
NPI:1689275349
Name:COSTE, YDALINA INMACULADA (ARNP)
Entity type:Individual
Prefix:
First Name:YDALINA
Middle Name:INMACULADA
Last Name:COSTE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 290054
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33329-0054
Mailing Address - Country:US
Mailing Address - Phone:908-208-9396
Mailing Address - Fax:
Practice Address - Street 1:101 E W T HARRIS BLVD STE 5201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3422
Practice Address - Country:US
Practice Address - Phone:704-547-1495
Practice Address - Fax:704-547-1861
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-07
Last Update Date:2025-01-10
Deactivation Date:2021-02-10
Deactivation Code:
Reactivation Date:2024-02-20
Provider Licenses
StateLicense IDTaxonomies
WI20-435246ZC0007X
FL11030383363L00000X, 363LF0000X
NC5021258363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner