MEDICARE: KRISTINE A. KOCIN AGACNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	APRN.CNP.00027731	OH

General Provider Information

NPI Number	:	1316544786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE A. KOCIN AGACNP

Provider Business Mailing Address
First Line	:	1919 BISHOP RD
Second Line	:
City	:	WICKLIFFE
State	:	OH
Zip	:	44092-2518
Country	:	US
Telephone Number	:	440-488-9435
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 BISHOP RD
Second Line	:
City	:	WICKLIFFE
State	:	OH
Zip	:	44092-2518
Country	:	US
Telephone Number	:	440-488-9435
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2020
Last Update Date	:	10/07/2020

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