Provider Demographics
NPI:1386902690
Name:KAZAKOVA, ANNA (NP)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:KAZAKOVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 BRIGHTON 12TH ST APT E7
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5721
Mailing Address - Country:US
Mailing Address - Phone:917-355-1414
Mailing Address - Fax:
Practice Address - Street 1:3029 BRIGHTON 12TH ST APT E7
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5721
Practice Address - Country:US
Practice Address - Phone:917-355-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY521848-1163W00000X
NY309553363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty