Healthcare Provider Details

I. General information

NPI: 1386902690
Provider Name (Legal Business Name): ANNA KAZAKOVA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3029 BRIGHTON 12TH ST APT E7
BROOKLYN NY
11235-5721
US

IV. Provider business mailing address

3029 BRIGHTON 12TH ST APT E7
BROOKLYN NY
11235-5721
US

V. Phone/Fax

Practice location:
  • Phone: 917-355-1414
  • Fax:
Mailing address:
  • Phone: 917-355-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number309553
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF405574
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: