Healthcare Provider Details

I. General information

NPI: 1104926492
Provider Name (Legal Business Name): KAREN KOACH AP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3872 SHERIDAN ST
HOLLYWOOD FL
33021
US

IV. Provider business mailing address

1625 SE 10TH AVE #610
FORT LAUDERDALE FL
33316-2975
US

V. Phone/Fax

Practice location:
  • Phone: 954-987-9929
  • Fax: 954-987-7044
Mailing address:
  • Phone: 954-760-7617
  • Fax: 954-760-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP991
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: