Healthcare Provider Details

I. General information

NPI: 1972567329
Provider Name (Legal Business Name): JUDITH ANN KOSTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDITH ANN BERLINSKI

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2043 LITTLE RD
TRINITY FL
34655
US

IV. Provider business mailing address

PO BOX 21686
TAMPA FL
33622-1686
US

V. Phone/Fax

Practice location:
  • Phone: 727-846-7000
  • Fax: 877-260-1182
Mailing address:
  • Phone: 813-343-5500
  • Fax: 866-462-7445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9102477
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA000708L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: