Provider Demographics
NPI:1922991363
Name:FUHRMAN, COULTON NASH
Entity type:Individual
Prefix:
First Name:COULTON
Middle Name:NASH
Last Name:FUHRMAN
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 1:415 IMPERIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4616
Mailing Address - Country:US
Mailing Address - Phone:863-899-3267
Mailing Address - Fax:
Practice Address - Street 1:415 IMPERIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4616
Practice Address - Country:US
Practice Address - Phone:863-899-3267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant