Provider Demographics
NPI:1578228045
Name:MIODUCHOSKI, KARLA K (ARNP)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:K
Last Name:MIODUCHOSKI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 RIVERSIDE DR APT 110
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7020
Mailing Address - Country:US
Mailing Address - Phone:954-203-8795
Mailing Address - Fax:
Practice Address - Street 1:7421 N UNIVERSITY DR STE 306
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-6102
Practice Address - Country:US
Practice Address - Phone:954-721-8945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011694363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily