MEDICARE: MS. SAMANTHA BEVERLY KOZAKIEWICZ AUD

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	174400000X	Specialist	AY2644	FL
2	231H00000X	Audiologist	AY2644	FL
3	237600000X	Audiologist-Hearing Aid Fitter	AY2644	FL
4	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000	OTHER	FL	N/A
2	AY2644	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1962120741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SAMANTHA BEVERLY KOZAKIEWICZ AUD

Provider Business Mailing Address
First Line	:	8900 GLADIOLUS DR STE 201
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4492
Country	:	US
Telephone Number	:	239-267-7888
Fax Number	:	239-267-0409

Provider Business Practice Location Address
First Line	:	8900 GLADIOLUS DR STE 201
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4492
Country	:	US
Telephone Number	:	239-267-7888
Fax Number	:	239-267-0409

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

Provider Enumeration Date	:	08/18/2022
Last Update Date	:	12/09/2025

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Directions to “ MS. SAMANTHA BEVERLY KOZAKIEWICZ AUD” Practice Location

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