Provider Demographics
NPI:1609100445
Name:BOGDANOVA, ANNA LEONIDOVNA (PA)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:LEONIDOVNA
Last Name:BOGDANOVA
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Gender:F
Credentials:PA
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Mailing Address - Street 1:6265 SW 33RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4908
Mailing Address - Country:US
Mailing Address - Phone:305-281-5343
Mailing Address - Fax:305-574-2400
Practice Address - Street 1:6200 SW 73RD ST
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4679
Practice Address - Country:US
Practice Address - Phone:786-662-5253
Practice Address - Fax:786-662-5251
Is Sole Proprietor?:No
Enumeration Date:2009-09-27
Last Update Date:2009-09-27
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Provider Licenses
StateLicense IDTaxonomies
FLPAT9105154363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant