Provider Demographics
NPI:1073861936
Name:AUGUSTA, EVA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:AUGUSTA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 DERBY ST
Mailing Address - Street 2:SUITE #21
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4007
Mailing Address - Country:US
Mailing Address - Phone:781-556-5662
Mailing Address - Fax:781-836-0676
Practice Address - Street 1:175 DERBY ST
Practice Address - Street 2:SUITE 21
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4007
Practice Address - Country:US
Practice Address - Phone:781-556-5662
Practice Address - Fax:781-836-0676
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2270391363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health