Healthcare Provider Details

I. General information

NPI: 1982958534
Provider Name (Legal Business Name): JEFFREY A OSBORNE FNP, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 STATE ST STE 79
BANGOR ME
04401-5038
US

IV. Provider business mailing address

1025 KENDUSKEAG AVE
BANGOR ME
04401-2928
US

V. Phone/Fax

Practice location:
  • Phone: 513-600-7749
  • Fax: 207-579-8425
Mailing address:
  • Phone: 513-600-7749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP241564
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP241564
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: