Healthcare Provider Details

I. General information

NPI: 1538452164
Provider Name (Legal Business Name): CAROL-JO OSINSKI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROL-JO ROSEN FNP

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6031 INDUSTRIAL DR
GLOUCESTER VA
23061-3767
US

IV. Provider business mailing address

PO BOX 684
GLOUCESTER VA
23061-0684
US

V. Phone/Fax

Practice location:
  • Phone: 804-642-9515
  • Fax: 804-683-3691
Mailing address:
  • Phone: 804-642-9515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024164154
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: