DR. CARISSA J KOSTECKI MD
NPI 1720006828
Pediatrics - Pediatric Emergency Medicine in Jacksonville, FL

Q: What is Carissa Kostecki's NPI number?

The NPI number for Carissa Kostecki is 1720006828. It was assigned to this individual provider in the NPPES registry on July 17, 2006.

Q: What is Carissa Kostecki's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Emergency Medicine, with taxonomy code 2080P0204X.

Q: When was this NPI record last updated?

The NPPES record for Carissa Kostecki was last updated on April 17, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 17, 2006PECOS Enrolled

800 PRUDENTIAL DR, JACKSONVILLE, FL 32207(904) 396-5682(904) 346-0864 Get Directions Write a Review

NPPES record last updated: April 17, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Dr. Carissa J Kostecki Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. CARISSA J KOSTECKI MD (NPI 1720006828) is an individual pediatric emergency medicine provider in Jacksonville, Florida, licensed in Florida (ME85233) and active in the NPI registry since July 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1720006828

Entity TypeIndividualFemale

Primary Taxonomy2080P0204X

Provider Legal NameDR. CARISSA J KOSTECKICredential: MD

Location Address800 PRUDENTIAL DRJacksonville, FL 32207-8202

Mailing Address820 Prudential Dr Ste 713Jacksonville, FL 32207-8209 · (904) 396-5682 · Fax (904) 346-0864

Phone(904) 396-5682

Fax(904) 346-0864

Sole ProprietorNo

Enumeration DateJuly 17, 2006

Last NPPES UpdateApril 17, 2008

✔ NPI 1720006828 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Pediatric Emergency MedicineAllopathic & Osteopathic Physicians

Taxonomy Code2080P0204X

License✔ Licensed in FL · ME85233

Definition

A pediatrician who has special qualifications to manage emergencies in infants and children.

800 PRUDENTIAL DR, Jacksonville, FL 32207

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Other Identifiers 6

Medicaid265150500FL

Medicare UPINH64979FL

Medicare PIN29056AFL

Medicare PIN29056ZFL

Other29056FL · Bcbs

Medicaid000960352AGA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Carissa J Kostecki Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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