Provider Demographics
NPI:1801031604
Name:COZZA, ELIZABETH (APRN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:COZZA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-1632
Mailing Address - Country:US
Mailing Address - Phone:203-779-5199
Mailing Address - Fax:
Practice Address - Street 1:10 PROGRESS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6216
Practice Address - Country:US
Practice Address - Phone:203-925-9600
Practice Address - Fax:203-925-0594
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT069345163W00000X
CT003883363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse