Provider Demographics
NPI:1306653100
Name:COSGROVE, COURTNEY E
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:E
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 BIRCHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4327
Mailing Address - Country:US
Mailing Address - Phone:201-580-0418
Mailing Address - Fax:
Practice Address - Street 1:1705 E BELT LINE RD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-9606
Practice Address - Country:US
Practice Address - Phone:972-393-8687
Practice Address - Fax:972-393-4975
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1171304363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics