Healthcare Provider Details

I. General information

NPI: 1548273238
Provider Name (Legal Business Name): KATHLEEN ANN MALCOLM BOUZA ARNP FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5258 LINTON BLVD #106
DELRAY BEACH FL
33484
US

IV. Provider business mailing address

6 FOREST HILLS LANE
BOCA RATON FL
33431
US

V. Phone/Fax

Practice location:
  • Phone: 561-495-0990
  • Fax: 561-495-8276
Mailing address:
  • Phone: 561-391-4022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP2832212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: