Healthcare Provider Details

I. General information

NPI: 1366043614
Provider Name (Legal Business Name): CHRISTI KOSHY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S PINE ISLAND RD
PLANTATION FL
33324-3920
US

IV. Provider business mailing address

122 W JOHN CARPENTER FWY STE 420
IRVING TX
75039-2014
US

V. Phone/Fax

Practice location:
  • Phone: 954-424-7000
  • Fax:
Mailing address:
  • Phone: 972-957-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11009394
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1017539
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1017539
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: