Provider Demographics
NPI:1003038787
Name:KOZLICA, JENNIFER DENISE (RN, MPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DENISE
Last Name:KOZLICA
Suffix:
Gender:F
Credentials:RN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LA PORTE DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-1304
Mailing Address - Country:US
Mailing Address - Phone:423-280-0470
Mailing Address - Fax:423-634-3139
Practice Address - Street 1:540 MCCALLIE AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2089
Practice Address - Country:US
Practice Address - Phone:423-634-5831
Practice Address - Fax:423-634-3139
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000124675163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health