Provider Demographics
NPI:1972375608
Name:MCCOSBY, FIORELLA DE LOS ANGELES
Entity Type:Individual
Prefix:
First Name:FIORELLA
Middle Name:DE LOS ANGELES
Last Name:MCCOSBY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:FIORELLA
Other - Middle Name:D
Other - Last Name:TZOBANAKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4716 MAPLETREE LOOP
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-8119
Mailing Address - Country:US
Mailing Address - Phone:813-728-2237
Mailing Address - Fax:
Practice Address - Street 1:4716 MAPLETREE LOOP
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-8119
Practice Address - Country:US
Practice Address - Phone:813-728-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily