Provider Demographics
NPI:1174517718
Name:COSIC, SANJA (MD)
Entity type:Individual
Prefix:
First Name:SANJA
Middle Name:
Last Name:COSIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 E BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-5303
Mailing Address - Country:US
Mailing Address - Phone:813-984-8846
Mailing Address - Fax:813-988-8827
Practice Address - Street 1:5001 E BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-5303
Practice Address - Country:US
Practice Address - Phone:813-984-8846
Practice Address - Fax:813-988-8827
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67362208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252248900Medicaid
FL252248900Medicaid
FLG63343Medicare UPIN