Provider Demographics
NPI:1558390955
Name:KOZLOWSKI, SANDRA M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:M
Last Name:KOZLOWSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2298
Mailing Address - Country:US
Mailing Address - Phone:727-581-8767
Mailing Address - Fax:727-581-2786
Practice Address - Street 1:1301 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2298
Practice Address - Country:US
Practice Address - Phone:727-584-7706
Practice Address - Fax:727-581-2786
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103053363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU40078AMedicare PIN
Q33243Medicare UPIN