Provider Demographics
NPI:1679649545
Name:KOZAK, JAIME LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:LYNN
Last Name:KOZAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6051 E CORTEZ DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4948
Mailing Address - Country:US
Mailing Address - Phone:602-900-9404
Mailing Address - Fax:602-903-6587
Practice Address - Street 1:7054 E COCHISE RD STE B230
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-4550
Practice Address - Country:US
Practice Address - Phone:602-900-9404
Practice Address - Fax:602-903-6587
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3257363A00000X
AZAZ3257363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ136293Medicare Oscar/Certification
AZQ54410Medicare UPIN