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General NPI Number Information
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NPI Number | 1710528880
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Entity Type | Individual
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Provider Name | SVETLANA KOZLOVA NP
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Gender | Female
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Dates
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Enumeration Date | 09/30/2019
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 1250 JESSE JEWELL PKWY SE STE 200
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City | GAINESVILLE
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State | GA
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Zip | 30501-3865
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Country | US
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Telephone | 770-297-7277
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Fax |
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Provider Business Mailing Address
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Address Line | 11350 MCCORMICK RD, EXECUTIVE PLAZA 1 SUITE 501
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City | HUNT VALLEY
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State | MD
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Zip | 21031
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Country | US
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Telephone | 410-329-1070
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Fax | 410-329-1054
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN252782
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License Number State | GA
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