MEDICARE: JESSICA SUE KOZIARA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1619267929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SUE KOZIARA

Provider Business Mailing Address
First Line	:	231 BOBWHITE DR
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32514-2715
Country	:	US
Telephone Number	:	517-204-1779
Fax Number	:

Provider Business Practice Location Address
First Line	:	293 PLANTATION HILL RD
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32561-4861
Country	:	US
Telephone Number	:	850-525-9295
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2011
Last Update Date	:	04/08/2011

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Directions to “ JESSICA SUE KOZIARA ” Practice Location

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