Provider Demographics
NPI:1700430279
Name:KOUZMINA, ELENA (APRN)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:KOUZMINA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 CORAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-4180
Mailing Address - Country:US
Mailing Address - Phone:954-248-3422
Mailing Address - Fax:800-970-6020
Practice Address - Street 1:130 JFK DR STE 138
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6631
Practice Address - Country:US
Practice Address - Phone:954-248-3422
Practice Address - Fax:800-970-6020
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL937252163W00000X
FL11003036363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology