Healthcare Provider Details

I. General information

NPI: 1962317776
Provider Name (Legal Business Name): TYLER VINCENZO COZZI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 SPRUCE ST RM 7.103
SAINT LOUIS MO
63103-2846
US

IV. Provider business mailing address

1222 SPRUCE ST RM 7.103
SAINT LOUIS MO
63103-2846
US

V. Phone/Fax

Practice location:
  • Phone: 206-815-7380
  • Fax:
Mailing address:
  • Phone: 206-815-7380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: