Provider Demographics
NPI:1538578059
Name:KOZAK JOY, DANIELLE M (APNP)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:M
Last Name:KOZAK JOY
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:M
Other - Last Name:HANSCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:951 MARINERS ISLAND BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1560
Mailing Address - Country:US
Mailing Address - Phone:772-217-4557
Mailing Address - Fax:
Practice Address - Street 1:951 MARINERS ISLAND BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94404-1560
Practice Address - Country:US
Practice Address - Phone:650-285-6927
Practice Address - Fax:888-352-7383
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5908-33363L00000X, 363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1538578059Medicaid
WIK400167825Medicare PIN