MEDICARE: JAIME LYNN KOZAK PA-C

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	363A00000X	Physician Assistant	3257	AZ
2	363A00000X	Physician Assistant	AZ3257	AZ

General Provider Information

NPI Number	:	1679649545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME LYNN KOZAK PA-C

Provider Business Mailing Address
First Line	:	6051 E CORTEZ DR
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-4948
Country	:	US
Telephone Number	:	602-900-9404
Fax Number	:	602-903-6587

Provider Business Practice Location Address
First Line	:	7054 E COCHISE RD STE B230
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85253-4550
Country	:	US
Telephone Number	:	602-900-9404
Fax Number	:	602-903-6587

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

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	06/10/2019

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Directions to “ JAIME LYNN KOZAK PA-C” Practice Location

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