Provider Demographics
NPI:1487845558
Name:COSGROVE, SUSAN ANN (RN,APRN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:RN,APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:928-759-5874
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:2120 CENTERPOINTE WEST DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-8487
Practice Address - Country:US
Practice Address - Phone:928-778-4581
Practice Address - Fax:928-776-1872
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2755363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ623754Medicaid