Provider Demographics
NPI:1770582090
Name:DE COSMO, ELIZABETH P (ARNP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:P
Last Name:DE COSMO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:P
Other - Last Name:CAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:339 CYPRESS PKWY STE 180
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3329
Mailing Address - Country:US
Mailing Address - Phone:407-933-1877
Mailing Address - Fax:407-933-1817
Practice Address - Street 1:40107 HWY 27
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837
Practice Address - Country:US
Practice Address - Phone:863-419-0692
Practice Address - Fax:863-419-1695
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1990142363LA2200X
FL1990142163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305492600Medicaid
P88290Medicare UPIN
ILK06830Medicare ID - Type Unspecified