Provider Demographics
NPI:1609013655
Name:KOSCHMEDER, AVNI DOSHI (PA)
Entity Type:Individual
Prefix:
First Name:AVNI
Middle Name:DOSHI
Last Name:KOSCHMEDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AVNI
Other - Middle Name:ATUL
Other - Last Name:DOSHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:19322 YELLOW CLOVER DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3546
Mailing Address - Country:US
Mailing Address - Phone:303-356-7471
Mailing Address - Fax:
Practice Address - Street 1:5379 PRIMROSE LAKE CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3521
Practice Address - Country:US
Practice Address - Phone:813-977-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104520363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY04N3OtherBCBS
FL119062700Medicaid