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General NPI Number Information
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NPI Number | 1831845866
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Entity Type | Individual
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Provider Name | TINA COSBY NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 602 E BALTIMORE PIKE
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City | MEDIA
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State | PA
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Zip | 19063-1735
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Country | US
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Telephone | 484-444-2834
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Fax | 484-444-2592
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Provider Business Mailing Address
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Address Line | 1108 ANGORA DR
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City | YEADON
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State | PA
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Zip | 19050-3402
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Country | US
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Telephone | 610-529-7210
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 26NJ01219300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | SP024153
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | SP024153
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License Number State | PA
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