Provider Demographics
NPI:1386538635
Name:KOLODZIEJCZAK, KARA
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:KOLODZIEJCZAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 BAY RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3715
Mailing Address - Country:US
Mailing Address - Phone:305-987-9057
Mailing Address - Fax:
Practice Address - Street 1:2125 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-5031
Practice Address - Country:US
Practice Address - Phone:305-987-9057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207697163WP0808X
CT14891363LP0808X
FL9623359163WP0808X
FL11040281363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health