Individual ProviderDiana M CostaNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2817 Reilly St, Fort Bragg, NC 28310-4712(910) 907-8500PECOS EnrollmentBased on the most recent information from CMS, provider Diana M Costa does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 9:43 AM.Profile DetailsProvider ID1891200812Provider TypeIndividualFull NameCosta, Diana MTitleMrs.CredentialRNGenderFemaleSole ProprietorNoEnumeration Date12/13/2017Last Updated5/17/2022Contact InformationPractice LocationPractice Address2817 Reilly St, Fort Bragg, NC 28310-4712Phone(910) 907-8500FaxUnlisted FaxMailing LocationMailing Address4301 Jones Bridge Rd, Bethesda, MD 20814-4712PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense95015129CaliforniaCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicense736894California