Provider Demographics
NPI:1578036950
Name:KOZUBA, HEATHER (APN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:KOZUBA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 ASBURY AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-3536
Mailing Address - Country:US
Mailing Address - Phone:609-318-4922
Mailing Address - Fax:
Practice Address - Street 1:956 ASBURY AVE FL 2
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-3536
Practice Address - Country:US
Practice Address - Phone:609-318-4922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00892300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner