Healthcare Provider Details

I. General information

NPI: 1922758820
Provider Name (Legal Business Name): TRIANA MONEZ BOGGS APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 09/24/2023
Certification Date: 09/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S FLORIDA AVE
LAKELAND FL
33803-2655
US

IV. Provider business mailing address

2501 WALDEN WOODS DR # 3491
PLANT CITY FL
33566-7168
US

V. Phone/Fax

Practice location:
  • Phone: 863-683-4663
  • Fax:
Mailing address:
  • Phone: 813-365-9454
  • Fax: 813-798-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN11018205
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN9583963
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: