Provider Demographics
NPI:1831184662
Name:KOSTER, ERIC LAURENCE
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:LAURENCE
Last Name:KOSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MANGRUM DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-6162
Mailing Address - Country:US
Mailing Address - Phone:931-388-2596
Mailing Address - Fax:
Practice Address - Street 1:5073 COLUMBIA PIKE
Practice Address - Street 2:#100
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-8607
Practice Address - Country:US
Practice Address - Phone:615-302-0885
Practice Address - Fax:615-891-5003
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000141362363LF0000X
TNAPN0000011589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3641422Medicare UPIN