Provider Demographics
NPI:1972567329
Name:KOSTER, JUDITH ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:KOSTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:ANN
Other - Last Name:BERLINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 21686
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-1686
Mailing Address - Country:US
Mailing Address - Phone:813-343-5500
Mailing Address - Fax:866-462-7445
Practice Address - Street 1:2043 LITTLE RD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655
Practice Address - Country:US
Practice Address - Phone:727-846-7000
Practice Address - Fax:877-260-1182
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102477363AS0400X
PAMA000708L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291779300Medicaid
PAMA000708LOtherPENNSYLVANIA STATE BOARD OF MEDICINE
P00087680OtherRAILROAD MEDICARE
FLU1879Medicare ID - Type Unspecified
PAMA000708LOtherPENNSYLVANIA STATE BOARD OF MEDICINE