Provider Demographics
NPI:1710233937
Name:VAN KOUGHNETT, JULIE ANN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE ANN
Middle Name:MARIE
Last Name:VAN KOUGHNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1494 SPRINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2742
Mailing Address - Country:US
Mailing Address - Phone:519-859-7899
Mailing Address - Fax:
Practice Address - Street 1:1494 SPRINGSIDE DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2742
Practice Address - Country:US
Practice Address - Phone:519-859-7899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN17127208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery