Healthcare Provider Details

I. General information

NPI: 1215825542
Provider Name (Legal Business Name): JENNA COSENTINO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8821 COLUMBIA 100 PKWY
COLUMBIA MD
21045-2274
US

IV. Provider business mailing address

1304 BEAUMONT CT
FOREST HILL MD
21050-2409
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-1700
  • Fax:
Mailing address:
  • Phone: 410-746-1379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR238385
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: