Provider Demographics
NPI:1700500477
Name:KOSMIDES, GENA (CRNP-PMHNP)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:KOSMIDES
Suffix:
Gender:F
Credentials:CRNP-PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 EDWARDS RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-6021
Mailing Address - Country:US
Mailing Address - Phone:301-697-1153
Mailing Address - Fax:
Practice Address - Street 1:175 HARRY S TRUMAN PKWY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7573
Practice Address - Country:US
Practice Address - Phone:667-204-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR178861363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA