Healthcare Provider Details

I. General information

NPI: 1841166766
Provider Name (Legal Business Name): DOMINIKA KATARZYNA KOZAKIEWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOMINIKA KATARZYNA LIGEZA

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 HEATHERFIELD LN
SPRING HILL TN
37174-0500
US

IV. Provider business mailing address

903 HEATHERFIELD LN
SPRING HILL TN
37174-0500
US

V. Phone/Fax

Practice location:
  • Phone: 347-610-8454
  • Fax:
Mailing address:
  • Phone: 347-610-8454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number40065
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: