Provider Demographics
NPI:1376538074
Name:BOZEMAN, PATRICIA K (APRN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:K
Last Name:BOZEMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:KRAWIEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 911
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-522-4158
Mailing Address - Fax:860-524-2652
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 911
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-522-4158
Practice Address - Fax:860-524-2652
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003251364SM0705X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT06-1406459OtherPRIVATE HEALTHCARE SYSTEMS
CT06-1406459OtherMULTIPLAN
CT3V4422OtherHEALTH NET
CT030251OtherCONNECTICARE
CT1376538074OtherANTHEM BCBS
CT06-1406459OtherNORTHEAST HEALTH DIRECT
CT497353OtherWELLCARE
CT06-1406459OtherGREAT WEST HEALTHCARE
CT06-1406459OtherTRICARE
CT06-1406459OtherPIONEER
CT06-1406459OtherCORVEL
CTP00789541OtherRAILROAD MEDICARE
CT06-1406459OtherCOMMUNITY HEALTH NETWORK
CT1376538074OtherAETNA BETTER HEALTH
CT3V4422OtherHEALTH NET