Healthcare Provider Details

I. General information

NPI: 1073386413
Provider Name (Legal Business Name): BRITTANY NICOLE KOZLAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 ROCKY RIVER DR
CLEVELAND OH
44111-4153
US

IV. Provider business mailing address

3929 ROCKY RIVER DR
CLEVELAND OH
44111-4153
US

V. Phone/Fax

Practice location:
  • Phone: 216-252-5800
  • Fax:
Mailing address:
  • Phone: 216-252-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0034551
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: