Healthcare Provider Details

I. General information

NPI: 1740002708
Provider Name (Legal Business Name): TANYA YANEVA KOZIOL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29000 CENTER RIDGE RD
WESTLAKE OH
44145-5219
US

IV. Provider business mailing address

27385 TILLER DR # 27385
OLMSTED TWP OH
44138-1771
US

V. Phone/Fax

Practice location:
  • Phone: 440-847-9956
  • Fax:
Mailing address:
  • Phone: 216-973-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024005808
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: