Healthcare Provider Details

I. General information

NPI: 1477863264
Provider Name (Legal Business Name): AHLAM N WOLF PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 VERSAILLES ST
SARASOTA FL
34239-6900
US

IV. Provider business mailing address

1945 VERSAILLES ST
SARASOTA FL
34239-6900
US

V. Phone/Fax

Practice location:
  • Phone: 941-365-0770
  • Fax:
Mailing address:
  • Phone: 941-365-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number10001239
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: