Healthcare Provider Details

I. General information

NPI: 1578102471
Provider Name (Legal Business Name): CATHERINE COSGRAVE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 DEPOT ST
KINGFIELD ME
04947-4208
US

IV. Provider business mailing address

5903 SUNSET BLVD
FORT PIERCE FL
34982-7529
US

V. Phone/Fax

Practice location:
  • Phone: 207-265-4555
  • Fax: 207-265-5004
Mailing address:
  • Phone: 772-577-0552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11005121
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: