MEDICARE: BOGDAN-GABRIEL COZMUTA 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	PA9111486	FL

General Provider Information

NPI Number	:	1902208077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOGDAN-GABRIEL COZMUTA PA-C

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE 2ND FLOOR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-1977
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:	239-599-2612

Provider Business Practice Location Address
First Line	:	400 8TH STREET NORTH
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-7906
Country	:	US
Telephone Number	:	239-241-7722
Fax Number	:	239-529-6629

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

Provider Enumeration Date	:	09/20/2014
Last Update Date	:	10/14/2019

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Directions to “ BOGDAN-GABRIEL COZMUTA PA-C” Practice Location

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