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General NPI Number Information
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NPI Number | 1366501009
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Entity Type | Individual
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Provider Name | CHRISTINE ANNMARIE DAVIS-FOWLER PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 4410 W. OAKLAND PARK BLVD
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313
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Country | US
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Telephone | 954-533-5900
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Fax | 954-533-3005
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Provider Business Mailing Address
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Address Line | 599 S FEDERAL HWY
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City | DANIA BEACH
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State | FL
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Zip | 33004-4107
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Country | US
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Telephone | 954-920-4911
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Fax | 954-922-9308
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9102369
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License Number State | FL
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