Mariya Bozhenok, PA-C

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

PA9106816 Issued in FL

Practice address

4101 Evans Ave
Fort Myers, FL 33901

Phone

(239) 939-3456

Fax

(239) 790-2432

NPI assigned

Oct 10, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464739200000",
    "number": "1194077487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 111600",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341080127",
            "telephone_number": "239-333-0630",
            "fax_number": "239-333-0631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 EVANS AVE",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "33901",
            "telephone_number": "239-939-3456",
            "fax_number": "239-790-2432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOZHENOK",
        "first_name": "MARIYA",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-10",
        "last_updated": "2016-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "PA9106816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alan J Boyd III, NREMT-P
• Candace M Boyd, RN
• Edward George Boyer IV, M.D.
• William Richard Boyer, LMHC
• Leah Baker Boyette, MD
• Hal Leslie Bozof, D.P.M.
• Brian Wayne Bozza, M.D.
• Brian Paul Bracher, RN
• Lori Ann Brackett, MSN, FNP-BC
• Kelly A Braden, PT

• Primary Care Nurse Practitioner in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Primary Care Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.