Healthcare Provider Details

I. General information

NPI: 1427550045
Provider Name (Legal Business Name): ALEXIS LEIGH KOZICH APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 W VIRGINIA AVE
TAMPA FL
33607-6330
US

IV. Provider business mailing address

2816 W VIRGINIA AVE
TAMPA FL
33607-6330
US

V. Phone/Fax

Practice location:
  • Phone: 813-876-6321
  • Fax: 813-870-0350
Mailing address:
  • Phone: 813-876-6321
  • Fax: 813-870-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9316654
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: