Individual
DR. LISA A COSGROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
270 N SYKES CREEK PKWY, UNIT 108, MERRITT ISLAND, FL 32953
(321) 452-1061
(321) 453-0866
Mailing address
PO BOX 541216, MERRITT ISLAND, FL 32954-1216
(321) 452-1061
(321) 453-0866
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME59169
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18653
BLUE CROSS BLUE SHIELD FL
FL
05
—
372574000
—
FL
Enumeration date
05/01/2006
Last updated
09/22/2016
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