MEDICARE: MS. RAYMA NICOLE COSLETT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1104996677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RAYMA NICOLE COSLETT PA-C

Provider Business Mailing Address
First Line	:	NAVAL MEDICAL CENTER PORTSMOUTH
Second Line	:	620 JOHN PAUL JONES CIRCLE
City	:	PORTSMOUTH
State	:	VA
Zip	:	23708
Country	:	US
Telephone Number	:	757-953-5113
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 MAIN RD STE 1806
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23691-5111
Country	:	US
Telephone Number	:	757-953-8437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	06/15/2022

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