Healthcare Provider Details

I. General information

NPI: 1710211602
Provider Name (Legal Business Name): CRISTEN KOSLIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10,000 BAY PINES BLVD POST OFFICE BOX 5005
BAY PINES FL
33744
US

IV. Provider business mailing address

318 25TH AVE N
ST PETERSBURG FL
33704-3448
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-6661
  • Fax: 727-319-1264
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: