=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538770755
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELENA BOGATOVA APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2020
-----------------------------------------------------
Last Update Date | 08/11/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6770 INDIAN CREEK DR APT 5S
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33141-5749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-333-4694
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6770 INDIAN CREEK DR APT 5S
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33141-5749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-333-4694
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 11008182
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------