Provider Demographics
NPI:1316132061
Name:SOFFLER, JUDITH KAREN (ARNP)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:KAREN
Last Name:SOFFLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:KAREN
Other - Last Name:GLICK-SOFFLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4045 MIZNER CIRCLE SOUTH
Mailing Address - Street 2:
Mailing Address - City:JAX
Mailing Address - State:FL
Mailing Address - Zip Code:32217
Mailing Address - Country:US
Mailing Address - Phone:904-448-8613
Mailing Address - Fax:
Practice Address - Street 1:555 STOCKTON STREET
Practice Address - Street 2:
Practice Address - City:JAX
Practice Address - State:FL
Practice Address - Zip Code:32204
Practice Address - Country:US
Practice Address - Phone:904-387-4661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2556802363LA2200X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily