Provider Demographics
NPI:1083203053
Name:KOHLBUS, HOPE C
Entity Type:Individual
Prefix:
First Name:HOPE
Middle Name:C
Last Name:KOHLBUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15125 PARKSIDE DR APT 4
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-5106
Mailing Address - Country:US
Mailing Address - Phone:717-891-0188
Mailing Address - Fax:
Practice Address - Street 1:9021 PARK ROYAL DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9617
Practice Address - Country:US
Practice Address - Phone:239-432-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant