Provider Demographics
NPI:1023353125
Name:SUNCOAST HERNANDO SURGICAL ASSISTING INC
Entity type:Organization
Organization Name:SUNCOAST HERNANDO SURGICAL ASSISTING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:352-592-4696
Mailing Address - Street 1:5115 SUWANNEE RD
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34607-2354
Mailing Address - Country:US
Mailing Address - Phone:352-592-4696
Mailing Address - Fax:
Practice Address - Street 1:5115 SUWANNEE RD
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34607-2354
Practice Address - Country:US
Practice Address - Phone:352-592-4696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-01
Last Update Date:2012-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102477363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty