Provider Demographics
NPI:1366501009
Name:DAVIS-FOWLER, CHRISTINE ANNMARIE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANNMARIE
Last Name:DAVIS-FOWLER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:599 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-4107
Mailing Address - Country:US
Mailing Address - Phone:954-920-4911
Mailing Address - Fax:954-922-9308
Practice Address - Street 1:4410 W. OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313
Practice Address - Country:US
Practice Address - Phone:954-533-5900
Practice Address - Fax:954-533-3005
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant