=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114217122
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OKSANA KORECKAYA A.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2011
-----------------------------------------------------
Last Update Date | 04/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3501 1ST AVE S
-----------------------------------------------------
City | SAINT PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33711-1303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-755-3335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 113 YACHT CLUB CIR
-----------------------------------------------------
City | NORTH REDINGTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33708-1583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-755-3335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AP2872
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------