Healthcare Provider Details

I. General information

NPI: 1356092811
Provider Name (Legal Business Name): JOY R FOWLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2022
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 HOLLYWOOD BLVD STE PHE
HOLLYWOOD FL
33021-6760
US

IV. Provider business mailing address

3500 MONROE ST APT 115
HOLLYWOOD FL
33021-7579
US

V. Phone/Fax

Practice location:
  • Phone: 954-822-4175
  • Fax:
Mailing address:
  • Phone: 786-438-9675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-2843480
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: