Healthcare Provider Details

I. General information

NPI: 1205037918
Provider Name (Legal Business Name): FRANK KOLOVRAT JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 SW 17TH ST STE 200
OCALA FL
34471-1227
US

IV. Provider business mailing address

2909 MARKET ST
WILMINGTON NC
28403-1221
US

V. Phone/Fax

Practice location:
  • Phone: 352-877-3360
  • Fax:
Mailing address:
  • Phone: 910-687-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA6877
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-11215
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9113143
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: