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General NPI Number Information
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NPI Number | 1861030660
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Entity Type | Individual
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Provider Name | DIANELIS BOUZA APRN
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Gender | Female
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Dates
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Enumeration Date | 12/12/2019
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Last Update Date | 12/08/2024
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Provider Practice Location Address
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Address Line | 628 NW 22ND AVE
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City | MIAMI
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State | FL
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Zip | 33125-3305
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Country | US
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Telephone | 786-623-7074
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Fax |
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Provider Business Mailing Address
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Address Line | 2415 CENTERGATE DR APT 105
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City | MIRAMAR
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State | FL
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Zip | 33025-7284
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Country | US
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Telephone | 786-623-7074
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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 | 11004426
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License Number State | FL
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