Provider Demographics
NPI:1760264790
Name:COULAS, ALI ANDERSON (RN)
Entity Type:Individual
Prefix:MISS
First Name:ALI
Middle Name:ANDERSON
Last Name:COULAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FOREST HILL BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5617
Mailing Address - Country:US
Mailing Address - Phone:612-773-2735
Mailing Address - Fax:
Practice Address - Street 1:3600 FOREST HILL BLVD STE 2
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5617
Practice Address - Country:US
Practice Address - Phone:612-773-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9386874163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse