Provider Demographics
NPI:1104297290
Name:BOZA, MARISE
Entity type:Individual
Prefix:
First Name:MARISE
Middle Name:
Last Name:BOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2934 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-3210
Mailing Address - Country:US
Mailing Address - Phone:813-263-3500
Mailing Address - Fax:813-874-0240
Practice Address - Street 1:2934 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-3210
Practice Address - Country:US
Practice Address - Phone:813-263-3500
Practice Address - Fax:813-874-0240
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12737310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility