Provider Demographics
NPI:1831845866
Name:COSBY, TINA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:COSBY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 ANGORA DR
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-3402
Mailing Address - Country:US
Mailing Address - Phone:610-529-7210
Mailing Address - Fax:
Practice Address - Street 1:602 E BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1735
Practice Address - Country:US
Practice Address - Phone:484-444-2834
Practice Address - Fax:484-444-2592
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01219300207QA0505X
PASP024153207QA0505X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine