Healthcare Provider Details

I. General information

NPI: 1174451116
Provider Name (Legal Business Name): NYDEEN BAUZA MARTIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9980 CENTRAL PARK BLVD N STE 320
BOCA RATON FL
33428-1704
US

IV. Provider business mailing address

5851 HOLMBERG RD APT 313
PARKLAND FL
33067-4522
US

V. Phone/Fax

Practice location:
  • Phone: 561-488-2988
  • Fax:
Mailing address:
  • Phone: 561-667-7095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11047488
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: