Provider Demographics
NPI:1528185840
Name:MAYO, GINA COZZOLINO (MS, RNP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:COZZOLINO
Last Name:MAYO
Suffix:
Gender:F
Credentials:MS, RNP
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 910
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813-0901
Mailing Address - Country:US
Mailing Address - Phone:401-348-4074
Mailing Address - Fax:401-364-7694
Practice Address - Street 1:4099 OLD POST RD
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813-2553
Practice Address - Country:US
Practice Address - Phone:401-364-0770
Practice Address - Fax:401-364-7694
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01206363L00000X, 363LF0000X
RICNPP37401363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI413845OtherBLUE CHIP
RI050513332OtherUNITED HEALTH
RI32227#0OtherBCBS
RI413845OtherBLUE CHIP
RI007059292Medicare PIN