Kostecki, Carissa J

Kostecki, Carissa J is an individual health care provider with primary practice located at 800 Prudential Dr , Jacksonville FL 32207-8202. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine, which is considered as her primary health care specialty. Kostecki, Carissa J can be contacted via phone (904) 396-5682.

Contact Information

Primary practice address
800 Prudential Dr Jacksonville FL 32207-8202
Phone: (904) 396-5682
Fax: (904) 346-0864
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine 2080P0204X ME85233 Florida

Profile Details

NPI number 1720006828
LBN Legal business name Kostecki, Carissa J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 17th, 2006
Last updated Apr 17th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720006828 NPPES
Florida MEDICAID 265150500
Florida Other 29056
Florida MEDICAID 000960352A

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