Provider Demographics
NPI:1497742480
Name:KOHARIK, JANET ELIZABETH (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:ELIZABETH
Last Name:KOHARIK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9525 E OLD SPANISH TRL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-6631
Mailing Address - Country:US
Mailing Address - Phone:520-647-1319
Mailing Address - Fax:520-721-9798
Practice Address - Street 1:9525 E OLD SPANISH TRL
Practice Address - Street 2:SUITE 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-6631
Practice Address - Country:US
Practice Address - Phone:520-647-1319
Practice Address - Fax:520-721-9798
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1629122363LF0000X
AZAP3752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305488800Medicaid
FLY7172YMedicare PIN
FL305488800Medicaid