Provider Demographics
NPI:1164024550
Name:COSGROVE, EMILY NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:NICOLE
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 COPENA DR
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-3703
Mailing Address - Country:US
Mailing Address - Phone:205-266-3234
Mailing Address - Fax:
Practice Address - Street 1:927 COPENA DR
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-3703
Practice Address - Country:US
Practice Address - Phone:205-266-3234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant