Healthcare Provider Details

I. General information

NPI: 1891270740
Provider Name (Legal Business Name): CAROL F BOAZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MILESTONE RD
DANBURY CT
06810-5114
US

IV. Provider business mailing address

72 ENGISH LANE
SHELTON CT
06484-5363
US

V. Phone/Fax

Practice location:
  • Phone: 203-702-7400
  • Fax:
Mailing address:
  • Phone: 262-490-0171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number7540
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: