MEDICARE: MRS. ANNA KAZAKOVA NP

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	163W00000X	Registered Nurse	521848-1	NY
2	363LA2200X	Adult Health Nurse Practitioner	309553	NY

General Provider Information

NPI Number	:	1386902690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNA KAZAKOVA NP

Provider Business Mailing Address
First Line	:	3029 BRIGHTON 12TH ST APT E7
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5721
Country	:	US
Telephone Number	:	917-355-1414
Fax Number	:

Provider Business Practice Location Address
First Line	:	3029 BRIGHTON 12TH ST APT E7
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5721
Country	:	US
Telephone Number	:	917-355-1414
Fax Number	:

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

Provider Enumeration Date	:	04/25/2012
Last Update Date	:	02/25/2020

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