Provider Demographics
NPI:1689860314
Name:BOZZO-POLANCO, LUISA (CNM, ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LUISA
Middle Name:
Last Name:BOZZO-POLANCO
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11760 SW 40 ST #518
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3598
Mailing Address - Country:US
Mailing Address - Phone:305-553-2888
Mailing Address - Fax:305-553-0291
Practice Address - Street 1:11760 SW 40TH ST STE 518
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3598
Practice Address - Country:US
Practice Address - Phone:305-553-2888
Practice Address - Fax:305-553-0291
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2523572367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife