Provider Demographics
NPI:1235708645
Name:BOCANEGRA, ELIZABETH (APRN, NP-C, RN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:BOCANEGRA
Suffix:
Gender:F
Credentials:APRN, NP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19056 PARK RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33332-2500
Mailing Address - Country:US
Mailing Address - Phone:954-980-5467
Mailing Address - Fax:
Practice Address - Street 1:18100 NE 19TH AVE # 102
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1606
Practice Address - Country:US
Practice Address - Phone:305-948-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9476487163W00000X
FL11013197363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse