Provider Demographics
NPI:1619683570
Name:GOZ, KAITLYNNE
Entity Type:Individual
Prefix:
First Name:KAITLYNNE
Middle Name:
Last Name:GOZ
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 1:1431 S KINGSWAY RD
Mailing Address - Street 2:PO BOX 622
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584
Mailing Address - Country:US
Mailing Address - Phone:813-530-4428
Mailing Address - Fax:813-491-7675
Practice Address - Street 1:711 PARSONS POINTE ST
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-7804
Practice Address - Country:US
Practice Address - Phone:813-530-4428
Practice Address - Fax:813-491-7675
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician