Provider Demographics
NPI:1659846566
Name:COUSO, JENNIFER (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:COUSO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ROUTE 9 N STE 302
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-1200
Mailing Address - Country:US
Mailing Address - Phone:732-634-0036
Mailing Address - Fax:732-634-9182
Practice Address - Street 1:1000 ROUTE 9 N STE 302
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-1200
Practice Address - Country:US
Practice Address - Phone:732-634-0036
Practice Address - Fax:732-634-9182
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-06
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00862800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily