Decosta, Jettaya Ties'E

Decosta, Jettaya Ties'E is an individual health care provider with primary practice located at 124 Old Quogue Rd , Riverhead NY 11901-3941. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Licensed Practical Nurse, Nursing Service Providers / Registered Nurse. Nursing Service Providers / Registered Nurse is her primary health care specialty. Decosta, Jettaya Ties'E can be contacted via phone (631) 494-8488.

Contact Information

Primary practice address
124 Old Quogue Rd Riverhead NY 11901-3941
Phone: (631) 494-8488
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Licensed Practical Nurse 164W00000X 313600-1 New York
Nursing Service Providers / Registered Nurse 163W00000X 768677 New York

Profile Details

NPI number 1679815427
LBN Legal business name Decosta, Jettaya Ties'E
Credentials Registered Nurse (RN)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 20th, 2013
Last updated Apr 30th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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