Healthcare Provider Details

I. General information

NPI: 1558094037
Provider Name (Legal Business Name): HANNA KOZINA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2022
Last Update Date: 01/21/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 PLAZA DR STE 270
HIGHLANDS RANCH CO
80129-2508
US

IV. Provider business mailing address

640 PLAZA DR STE 270
HIGHLANDS RANCH CO
80129-2508
US

V. Phone/Fax

Practice location:
  • Phone: 303-626-8501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5779
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8663
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: