Provider Demographics
NPI:1790718161
Name:KOLOSKY, FRANK JOHN (PA)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:JOHN
Last Name:KOLOSKY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:985 STATE ROAD 436
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5664
Mailing Address - Country:US
Mailing Address - Phone:407-831-5252
Mailing Address - Fax:407-831-3765
Practice Address - Street 1:985 STATE ROAD 436
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5664
Practice Address - Country:US
Practice Address - Phone:407-831-5252
Practice Address - Fax:407-831-3765
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 1938363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004490400Medicaid
FLP00960472OtherRAILROAD MEDICARE
FLE2307WMedicare PIN
FLE2307YMedicare PIN
FLP00960472OtherRAILROAD MEDICARE