Provider Demographics
NPI:1508431321
Name:COZINE, JERUD ROBERT (NP)
Entity Type:Individual
Prefix:
First Name:JERUD
Middle Name:ROBERT
Last Name:COZINE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 8TH AVE SE STE 300
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-2106
Mailing Address - Country:US
Mailing Address - Phone:319-861-7200
Mailing Address - Fax:319-861-7201
Practice Address - Street 1:788 8TH AVE SE STE 300
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2106
Practice Address - Country:US
Practice Address - Phone:319-861-7200
Practice Address - Fax:319-861-7201
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA162492363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner