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General NPI Number Information
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NPI Number | 1275235590
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Entity Type | Individual
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Provider Name | KENZI LEE BOMAN
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Gender | Female
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 8320 W SUNRISE BLVD STE 208
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City | PLANTATION
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State | FL
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Zip | 33322-5432
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Country | US
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Telephone | 800-640-3451
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Fax |
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Provider Business Mailing Address
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Address Line | 211 ROSELING XING
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City | DAVENPORT
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State | FL
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Zip | 33897-3858
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Country | US
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Telephone | 801-663-6195
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11025232
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License Number State | FL
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