Provider Demographics
NPI:1821086745
Name:KOLANKO, JOSHUA E (C-FNP)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:E
Last Name:KOLANKO
Suffix:
Gender:M
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-0022
Mailing Address - Country:US
Mailing Address - Phone:813-226-3332
Mailing Address - Fax:813-793-7644
Practice Address - Street 1:16025 MUIRFIELD DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-2861
Practice Address - Country:US
Practice Address - Phone:813-226-3332
Practice Address - Fax:813-793-7644
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVMK1233357207Q00000X
FLARPR9328710363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008481300Medicaid
FLY048RQOtherMEDICARE
WV3810002050Medicaid
WVQ12464Medicare UPIN