Provider Demographics
NPI:1346622487
Name:COSTANZO BROWN, JAMIE J (FNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:J
Last Name:COSTANZO BROWN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:J
Other - Last Name:COSTANZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:200 HYGEIA DR
Mailing Address - Street 2:CCHS PHYSICIAN CONTRACTING, SUITE 2300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4755 OGLETOWN STANTON RD
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-733-6050
Practice Address - Fax:302-733-6074
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000815363LF0000X
DEL1-0036412163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse