Provider Demographics
NPI:1104531193
Name:KOCIK, ADRIANNA M (FNP-C)
Entity type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:M
Last Name:KOCIK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 N NORTHWEST HWY APT 318
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3357
Mailing Address - Country:US
Mailing Address - Phone:847-274-0663
Mailing Address - Fax:
Practice Address - Street 1:7900 N MILWAUKEE AVE STE 2-29
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3237
Practice Address - Country:US
Practice Address - Phone:847-454-9181
Practice Address - Fax:847-454-9184
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209025068363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty