Individual
DR. CARISSA J KOSTECKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
800 PRUDENTIAL DR, JACKSONVILLE, FL 32207-8202
(904) 396-5682
(904) 346-0864
Mailing address
820 PRUDENTIAL DR STE 713, JACKSONVILLE, FL 32207-8209
(904) 396-5682
(904) 346-0864
Taxonomy
Speciality
Code
Description
License number
State
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
ME85233
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000960352A
—
GA
05
—
265150500
—
FL
01
—
29056
BCBS
FL
Enumeration date
07/17/2006
Last updated
04/17/2008
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