Provider Demographics
NPI:1164867180
Name:BOZAK, MARILYNN G (ARNP)
Entity Type:Individual
Prefix:
First Name:MARILYNN
Middle Name:G
Last Name:BOZAK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARILYNN
Other - Middle Name:
Other - Last Name:HORNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11716 PLUMOSA RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-3624
Mailing Address - Country:US
Mailing Address - Phone:813-968-4784
Mailing Address - Fax:
Practice Address - Street 1:11716 PLUMOSA RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-3624
Practice Address - Country:US
Practice Address - Phone:813-968-4784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2154412363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health