Basic Information
| Provider Information | |||||||||
| NPI: | 1851554711 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOHAN | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11105 STIRLING RD | ||||||||
| Address2: | |||||||||
| City: | COOPER CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333286316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546504426 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13550 SW 10TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330276445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544339501 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2008 | ||||||||
| LastUpdateDate: | 10/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 2520322 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LF0000X | ARNP2520322 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.