Individual
JENNA COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 HIGHLAND AVE, PROVIDENCE, RI 02906-2740
(401) 633-1100
Mailing address
180 WATERMAN AVE APT 319, NORTH PROVIDENCE, RI 02911-4105
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN02813
RI
Other
Enumeration date
09/28/2021
Last updated
09/28/2021
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