MEDICARE: SIMONA BORZA PMHNP, LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	200950102NP	OR

General Provider Information

NPI Number	:	1679933113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMONA BORZA PMHNP, LLC

Provider Business Mailing Address
First Line	:	9600 SW OAK ST
Second Line	:	SUITE 325
City	:	TIGARD
State	:	OR
Zip	:	97223-6583
Country	:	US
Telephone Number	:	503-805-7895
Fax Number	:	509-935-5884

Provider Business Practice Location Address
First Line	:	9600 SW OAK ST
Second Line	:	SUITE 325
City	:	TIGARD
State	:	OR
Zip	:	97223-6583
Country	:	US
Telephone Number	:	503-805-7895
Fax Number	:	509-935-5884

Authorized Official
Title or Position	:	OWNER
Name	:	SIMONA BORZA
Credential	:	PMHNP
Telephone Number	:	503-805-7895

Provider Enumeration Date	:	02/25/2016
Last Update Date	:	02/25/2016

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