Provider Demographics
NPI:1861941403
Name:KOSCIOLEK, CORRANDA (FNP-BC, DHA)
Entity type:Individual
Prefix:DR
First Name:CORRANDA
Middle Name:
Last Name:KOSCIOLEK
Suffix:
Gender:F
Credentials:FNP-BC, DHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26531 YNEZ RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4630
Mailing Address - Country:US
Mailing Address - Phone:180-022-7990
Mailing Address - Fax:
Practice Address - Street 1:26531 YNEZ RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4630
Practice Address - Country:US
Practice Address - Phone:180-022-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF 11501363LF0000X, 363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000000000Medicaid