Provider Demographics
NPI:1891104766
Name:KOSEK, KALIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KALIE
Middle Name:
Last Name:KOSEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KALIE
Other - Middle Name:
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1360 E VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-9066
Mailing Address - Country:US
Mailing Address - Phone:941-488-2020
Mailing Address - Fax:941-484-2200
Practice Address - Street 1:1370 E VENICE AVE STE 205
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-9084
Practice Address - Country:US
Practice Address - Phone:941-488-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108019363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIA508ZMedicare PIN