Provider Demographics
NPI:1003335274
Name:DOUGLAS, ANNE-MARIA HOFMANN (APRN)
Entity Type:Individual
Prefix:
First Name:ANNE-MARIA
Middle Name:HOFMANN
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:772-336-2818
Mailing Address - Fax:772-336-5313
Practice Address - Street 1:1850 SW FOUNTAINVIEW BLVD STE 105
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-4527
Practice Address - Country:US
Practice Address - Phone:772-336-2818
Practice Address - Fax:772-336-5313
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9311035363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9311035OtherFLORIDA BOARD OF NURSING
FL022875400Medicaid
FLARNP9311035OtherFLORIDA BOARD OF NURSING