Individual
JESSICA ROSE DACOSTA
Active
Individual
JESSICA ROSE DACOSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, AGNP
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
Update your record
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