Active NPI
Micheline Costa Holmes, CRNP
- Family Nurse Practitioner
- Pocomoke City, MD
National Provider Identifier
1205405719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- R189395
- Practice address
- 305 10TH St Ste 104
Pocomoke City, MD 21851-1607 - Phone
- (410) 957-0273
- Fax
- (410) 957-0152
- NPI assigned
- Jun 18, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R189395 | MD | Primary |
Addresses
Primary practice location
305 10TH St Ste 104
Pocomoke City, MD 21851-1607
Mailing address
PO Box 1978
Salisbury, MD 21802-1978
Phone (410) 749-1015
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119591300 | Medicaid | MD |
Other names 1
- Ms. Micheline Aragao Costa
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DE
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tidalhealth Physician Network, Inc. | Current | Accepting new patients |
Locations
801 Middleford Rd
Seaford, DE 19973
Phone (302) 628-9178
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Seaford, DE
- NPI 1467534636
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626134400000",
"number": "1205405719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1978",
"city": "SALISBURY",
"state": "MD",
"postal_code": "218021978",
"telephone_number": "410-749-1015",
"fax_number": "410-749-0654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 10TH ST STE 104",
"city": "POCOMOKE CITY",
"state": "MD",
"postal_code": "218511607",
"telephone_number": "410-957-0273",
"fax_number": "410-957-0152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLMES",
"first_name": "MICHELINE",
"middle_name": "COSTA",
"name_prefix": "Mrs.",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-18",
"last_updated": "2021-07-13",
"certification_date": "2021-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MD",
"license": "R189395",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "119591300",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MICHELINE",
"last_name": "COSTA",
"middle_name": "ARAGAO",
"prefix": "MS.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Pocomoke City, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.