Provider Demographics
NPI:1215927702
Name:KOSTICK, ALEXANDRA MARION PAMELA (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:MARION PAMELA
Last Name:KOSTICK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3 PINE CONE DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8685
Mailing Address - Country:US
Mailing Address - Phone:386-446-9590
Mailing Address - Fax:386-446-2245
Practice Address - Street 1:3 PINE CONE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8685
Practice Address - Country:US
Practice Address - Phone:386-446-9590
Practice Address - Fax:386-446-2245
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2023-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME63389208D00000X, 207W00000X
MO107827208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250999700Medicaid
FLG08633Medicare UPIN