Provider Demographics
NPI:1174232102
Name:COSGRIFF, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:COSGRIFF
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 1:10509 SIDEBURN CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-2600
Mailing Address - Country:US
Mailing Address - Phone:571-643-3404
Mailing Address - Fax:
Practice Address - Street 1:9900 OLD KEENE MILL RD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3903
Practice Address - Country:US
Practice Address - Phone:703-250-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program