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General NPI Number Information
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NPI Number | 1194077487
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Entity Type | Individual
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Provider Name | MARIYA BOZHENOK PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/10/2012
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Last Update Date | 06/01/2016
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Provider Practice Location Address
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Address Line | 4101 EVANS AVE
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City | FORT MYERS
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State | FL
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Zip | 33901
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Country | US
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Telephone | 239-939-3456
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Fax | 239-790-2432
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Provider Business Mailing Address
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Address Line | PO BOX 111600
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City | NAPLES
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State | FL
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Zip | 34108-0127
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Country | US
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Telephone | 239-333-0630
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Fax | 239-333-0631
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | PA9106816
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License Number State | FL
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