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General NPI Number Information
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NPI Number | 1700372356
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Entity Type | Individual
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Provider Name | ANNE ELIZABETH DACOSTA PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/06/2018
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 2 DUDLEY ST STE 470
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City | PROVIDENCE
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State | RI
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Zip | 02905-3248
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Country | US
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Telephone | 401-228-0602
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Fax | 401-868-2320
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Provider Business Mailing Address
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Address Line | 47 SUNSET LAKE RD
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City | WARREN
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State | CT
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Zip | 06754-1701
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Country | US
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Telephone | 860-866-6938
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4157
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA7680
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA01259
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License Number State | RI
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