Provider Demographics
NPI:1568829000
Name:KOSKAN, KAYLEIGH
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:
Last Name:KOSKAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 W TENNESSEE ST
Mailing Address - Street 2:APT 14209
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-3118
Mailing Address - Country:US
Mailing Address - Phone:561-234-7660
Mailing Address - Fax:
Practice Address - Street 1:5017 OAK AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32466-2024
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other