Provider Demographics
NPI:1457930158
Name:ROSA, SELMA COSTA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SELMA
Middle Name:COSTA
Last Name:ROSA
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 1:117 DOWD ST
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2608
Mailing Address - Country:US
Mailing Address - Phone:860-250-9017
Mailing Address - Fax:
Practice Address - Street 1:117 DOWD ST
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2608
Practice Address - Country:US
Practice Address - Phone:860-250-9017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.009476363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner