Healthcare Provider Details

I. General information

NPI: 1861060840
Provider Name (Legal Business Name): BRITTANY BOZEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 SILVER SAGE LN
ST AUGUSTINE FL
32095-9015
US

IV. Provider business mailing address

167 SILVER SAGE LN
ST AUGUSTINE FL
32095-9015
US

V. Phone/Fax

Practice location:
  • Phone: 352-339-6510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: