Provider Demographics
NPI:1578310629
Name:THEOC, ULRICK
Entity type:Individual
Prefix:
First Name:ULRICK
Middle Name:
Last Name:THEOC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 N STATE ROAD 7 STE 220
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-3772
Mailing Address - Country:US
Mailing Address - Phone:954-444-2107
Mailing Address - Fax:
Practice Address - Street 1:2331 N STATE ROAD 7 STE 220
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-3772
Practice Address - Country:US
Practice Address - Phone:954-444-2107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11032607363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily