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General NPI Number Information
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NPI Number | 1558313775
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Entity Type | Individual
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Provider Name | KAREN BOEHMKE PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 4550 EXECUTIVE DR SUITE 104
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City | NAPLES
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State | FL
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Zip | 34119-8805
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Country | US
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Telephone | 239-566-1226
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Fax | 239-566-2519
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Provider Business Mailing Address
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Address Line | 4550 EXECUTIVE DR SUITE 104
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City | NAPLES
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State | FL
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Zip | 34119-8805
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Country | US
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Telephone | 239-566-1226
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Fax | 239-566-2519
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0161260-22
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-0981
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9108291
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.002976
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License Number State | OH
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