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General NPI Number Information
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NPI Number | 1821086745
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Entity Type | Individual
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Provider Name | JOSHUA E KOLANKO C-FNP
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Gender | Male
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 16025 MUIRFIELD DR
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City | ODESSA
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State | FL
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Zip | 33556-2861
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Country | US
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Telephone | 813-226-3332
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Fax | 813-793-7644
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Provider Business Mailing Address
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Address Line | PO BOX 22
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City | ODESSA
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State | FL
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Zip | 33556-0022
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Country | US
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Telephone | 813-226-3332
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Fax | 813-793-7644
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MK1233357
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARPR9328710
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License Number State | FL
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