Provider Demographics
NPI:1669059119
Name:COHEN, LONI SIMONE (PA)
Entity type:Individual
Prefix:
First Name:LONI
Middle Name:SIMONE
Last Name:COHEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17940 N MILITARY TRL
Mailing Address - Street 2:300
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496
Mailing Address - Country:US
Mailing Address - Phone:735-856-1994
Mailing Address - Fax:
Practice Address - Street 1:17940 N MILITARY TRL
Practice Address - Street 2:300
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496
Practice Address - Country:US
Practice Address - Phone:735-856-1994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9114091363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant