Provider Demographics
NPI:1538581038
Name:KOZIK, CAROL ANNE (FNP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANNE
Last Name:KOZIK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 RUGBY RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-3225
Mailing Address - Country:US
Mailing Address - Phone:315-437-1693
Mailing Address - Fax:
Practice Address - Street 1:4446 S ONONDAGA RD
Practice Address - Street 2:
Practice Address - City:NEDROW
Practice Address - State:NY
Practice Address - Zip Code:13120-9766
Practice Address - Country:US
Practice Address - Phone:315-200-6689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily