Provider Demographics
NPI:1891867396
Name:CZOVEK, EDWIN (PHYS ASSISTANT)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:CZOVEK
Suffix:
Gender:M
Credentials:PHYS ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37840 MEDICAL ARTS CT
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-4325
Mailing Address - Country:US
Mailing Address - Phone:352-518-2000
Mailing Address - Fax:352-567-8125
Practice Address - Street 1:37840 MEDICAL ARTS CT
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541
Practice Address - Country:US
Practice Address - Phone:352-518-2000
Practice Address - Fax:352-567-8125
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002093363A00000X
FLPA9110250363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110001918Medicaid