Provider Demographics
NPI:1144417940
Name:COSLETT, JEFFREY SCOTT (SFIDC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:COSLETT
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 GALLANT FOX CIR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-1950
Mailing Address - Country:US
Mailing Address - Phone:858-602-2900
Mailing Address - Fax:904-270-6531
Practice Address - Street 1:USS UNDERWOOD (FFG 36)
Practice Address - Street 2:MEDICAL DEPARTMENT
Practice Address - City:FPO AA
Practice Address - State:FL
Practice Address - Zip Code:34093-1491
Practice Address - Country:US
Practice Address - Phone:904-270-5974
Practice Address - Fax:904-270-6531
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman