MEDICARE: MARIYA BOYCHEV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APRN11028420	FL

General Provider Information

NPI Number	:	1134886054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIYA BOYCHEV

Provider Business Mailing Address
First Line	:	3 RAMSGATE PL
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-6858
Country	:	US
Telephone Number	:	386-627-6069
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 HAND AVE STE I
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8195
Country	:	US
Telephone Number	:	386-673-0517
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2021
Last Update Date	:	10/26/2023

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