Individual
NICOLE KOZLAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-8063
(860) 679-3899
(860) 676-3476
Mailing address
263 FARMINGTON AVE, FARMINGTON, CT 06030-8063
(860) 679-3899
(860) 676-3476
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5292
CT
Other
Enumeration date
07/09/2021
Last updated
09/26/2022
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