Jettaya Ties'E Decosta, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

768677 Issued in NY

Practice address

124 Old Quogue Rd
Riverhead, NY 11901-3941

Phone

(631) 494-8488

NPI assigned

Mar 20, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556582400000",
    "number": "1679815427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1634",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119010604",
            "telephone_number": "631-494-8488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 OLD QUOGUE RD",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119013941",
            "telephone_number": "631-494-8488"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 Aldersgate",
            "address_2": "apt #412",
            "address_purpose": "LOCATION",
            "city": "Riverhead",
            "state": "NY",
            "postal_code": "119011832",
            "country_code": "US",
            "telephone_number": "631-494-8488",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DECOSTA",
        "first_name": "JETTAYA",
        "middle_name": "TIES'E",
        "name_prefix": "Ms.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-20",
        "last_updated": "2019-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "313600-1",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "768677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Davis
• Erin Christine Davis, LPN
• Rebecca F Davis, P.T.
• Catherine Rachel Dawson, LMSW
• Ksenia Decarle, RN
• Diane Del Percio, LCSW
• Toni Deleonardis, LMSW
• Stavroula Demakos, ANP
• Olivia Renee Demarco
• Michael William Dempsey, M.D.

• Registered Nurse in Riverhead, NY
• Providers in Riverhead, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.