Provider Demographics
NPI:1205828829
Name:COSENTINO, JOSEPH JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:COSENTINO
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6632 LOWER BURNINGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-6482
Mailing Address - Country:US
Mailing Address - Phone:828-349-9662
Mailing Address - Fax:
Practice Address - Street 1:100 BREWSTER BLVD
Practice Address - Street 2:NAVAL HOSPITAL CAMP LEJEUNE
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2538
Practice Address - Country:US
Practice Address - Phone:828-421-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN142849163W00000X
NC249887163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse