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General NPI Number Information
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NPI Number | 1700039161
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Entity Type | Organization
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Legal Business Name | ALEXANDRA KOSTICK MD PA
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 3 PINE CONE DR SUITE 104
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City | PALM COAST
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State | FL
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Zip | 32137-8685
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Country | US
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Telephone | 386-446-9590
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Fax |
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Provider Business Mailing Address
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Address Line | 3 PINE CONE DR SUITE 104
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City | PALM COAST
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State | FL
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Zip | 32137-8685
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Country | US
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Telephone | 386-446-9590
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ALEXANDRA MARION PAMELA KOSTICK
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Credential |
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Telephone | 386-446-9590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME63389
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License Number State | FL
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