Healthcare Provider Details

I. General information

NPI: 1932896867
Provider Name (Legal Business Name): BRENDAN KOSKO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 W UNDERWOOD ST
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

975 BENNETT RD APT 204
ORLANDO FL
32814-6200
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-5111
  • Fax:
Mailing address:
  • Phone: 407-808-9867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: