MEDICARE: ELIZABETH MARTIN BOADA APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	11038039	FL

General Provider Information

NPI Number	:	1003619818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MARTIN BOADA APRN

Provider Business Mailing Address
First Line	:	6866 W 2ND CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-5302
Country	:	US
Telephone Number	:	786-270-8093
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 N UNIVERSITY DR # A
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-3611
Country	:	US
Telephone Number	:	954-963-2151
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2025
Last Update Date	:	03/28/2025

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