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Individual

JESSICA ROSE DACOSTA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
APRN, AGNP

Contact information

Practice address
2 OLD NEW MILFORD RD STE 3D, BROOKFIELD, CT 06804-2426
(203) 885-0910
Mailing address
53 ELBOW HILL RD, BROOKFIELD, CT 06804-1905
(203) 947-6986

Taxonomy

Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
10496
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10496
CT DEP OF HEALTH
CT
Enumeration date
04/01/2022
Last updated
04/01/2022
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