Provider Demographics
NPI:1366075152
Name:KOZLICK, TIFFANY (FNP-BC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:KOZLICK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 CONSERVATORY LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-8913
Mailing Address - Country:US
Mailing Address - Phone:815-302-3283
Mailing Address - Fax:
Practice Address - Street 1:1300 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1451
Practice Address - Country:US
Practice Address - Phone:630-844-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.020846363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner