Healthcare Provider Details

I. General information

NPI: 1992133078
Provider Name (Legal Business Name): JULIE WEISS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2013
Last Update Date: 04/03/2021
Certification Date: 04/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

1613 HARRISON PKWY STE 200
SUNRISE FL
33323-2853
US

V. Phone/Fax

Practice location:
  • Phone: 954-987-5662
  • Fax: 954-962-6974
Mailing address:
  • Phone: 954-838-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA194
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: