Provider Demographics
NPI:1225182173
Name:BOSSE, ADELYNE (ARNP)
Entity Type:Individual
Prefix:
First Name:ADELYNE
Middle Name:
Last Name:BOSSE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 NW 126TH DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5411
Mailing Address - Country:US
Mailing Address - Phone:404-671-6773
Mailing Address - Fax:
Practice Address - Street 1:8790 W MCNAB RD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-3214
Practice Address - Country:US
Practice Address - Phone:954-726-6008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA173279363LF0000X
FLARNP9298656363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily