Healthcare Provider Details

I. General information

NPI: 1417536053
Provider Name (Legal Business Name): JULIA LYNN KOHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 06/27/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 S UNIVERSITY DRIVE
DAVIE FL
33314
US

IV. Provider business mailing address

1721 SE 17TH ST APT 643
FORT LAUDERDALE FL
33316-3152
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-7500
  • Fax:
Mailing address:
  • Phone: 845-705-0894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: