Healthcare Provider Details

I. General information

NPI: 1306578356
Provider Name (Legal Business Name): KOZETA JANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALBANY AVE
HARTFORD CT
06120-2508
US

IV. Provider business mailing address

29 NUTMEG DR
WORCESTER MA
01603-1249
US

V. Phone/Fax

Practice location:
  • Phone: 860-249-9625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number12496
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN2306676
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2306676
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: