1063537728 NPI number — MS. JULIE ANN COSENZA LMT

Table of content: MS. JULIE ANN COSENZA LMT (NPI 1063537728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063537728 NPI number — MS. JULIE ANN COSENZA LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COSENZA
Provider First Name:
JULIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063537728
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11321 SW 158TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARCHER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32618-3941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-495-7646
Provider Business Mailing Address Fax Number:
352-495-7646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1411 NW 6TH ST
Provider Second Line Business Practice Location Address:
UNIT 120
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32601-4021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-870-2381
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA15043 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C7068 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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