Provider Demographics
NPI:1205161874
Name:AGOSTA, CAITLIN ZANGARA (RN, APN,C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ZANGARA
Last Name:AGOSTA
Suffix:
Gender:F
Credentials:RN, APN,C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 LOIS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2906
Mailing Address - Country:US
Mailing Address - Phone:908-705-5704
Mailing Address - Fax:
Practice Address - Street 1:39 LOIS AVE
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:908-705-5704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2018-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12690200163WP0808X
NJ26NJ00837700363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health