Healthcare Provider Details

I. General information

NPI: 1578228045
Provider Name (Legal Business Name): KARLA K MIODUCHOSKI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7421 N UNIVERSITY DR STE 306
TAMARAC FL
33321-6102
US

IV. Provider business mailing address

995 RIVERSIDE DR APT 110
CORAL SPRINGS FL
33071-7020
US

V. Phone/Fax

Practice location:
  • Phone: 954-721-8945
  • Fax:
Mailing address:
  • Phone: 954-203-8795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11011694
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: