Provider Demographics
NPI:1194077487
Name:BOZHENOK, MARIYA (PA-C)
Entity type:Individual
Prefix:MS
First Name:MARIYA
Middle Name:
Last Name:BOZHENOK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111600
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-0127
Mailing Address - Country:US
Mailing Address - Phone:239-333-0630
Mailing Address - Fax:239-333-0631
Practice Address - Street 1:4101 EVANS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901
Practice Address - Country:US
Practice Address - Phone:239-939-3456
Practice Address - Fax:239-790-2432
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106816363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care