Provider Demographics
NPI:1134756323
Name:COSTAGLIOLA, JAIME JO (MSN, APN, CEN)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:JO
Last Name:COSTAGLIOLA
Suffix:
Gender:F
Credentials:MSN, APN, CEN
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:JO
Other - Last Name:MUSCIANESI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APN, CEN
Mailing Address - Street 1:1639 WEST PRINCETON AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRICK TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 COLLEGE DR STE 103
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2239
Practice Address - Country:US
Practice Address - Phone:732-797-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01028700363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology