Healthcare Provider Details

I. General information

NPI: 1063861649
Provider Name (Legal Business Name): MYRNA ZOE BOSQUES-TORRENS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 S OSPREY AVE STE A1
SARASOTA FL
34239
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-3407
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-7194
  • Fax: 941-917-4016
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME137532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: