Provider Demographics
NPI:1215363023
Name:KOHN, SOFIA NOOHANI (PA-C)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:NOOHANI
Last Name:KOHN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 MILITARY TRL STE 64
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2873
Mailing Address - Country:US
Mailing Address - Phone:561-263-7010
Mailing Address - Fax:561-776-3998
Practice Address - Street 1:5430 MILITARY TRL STE 64
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2873
Practice Address - Country:US
Practice Address - Phone:561-263-7010
Practice Address - Fax:561-776-3998
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107506363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant