MEDICARE: JOSHUA E KOLANKO C-FNP

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	207Q00000X	Family Medicine Physician	MK1233357	WV
2	363L00000X	Nurse Practitioner	ARPR9328710	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	Y048RQ	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821086745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA E KOLANKO C-FNP

Provider Business Mailing Address
First Line	:	PO BOX 22
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-0022
Country	:	US
Telephone Number	:	813-226-3332
Fax Number	:	813-793-7644

Provider Business Practice Location Address
First Line	:	16025 MUIRFIELD DR
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-2861
Country	:	US
Telephone Number	:	813-226-3332
Fax Number	:	813-793-7644

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	02/24/2022

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