Provider Demographics
NPI:1851809859
Name:BOZEMAN, TARYN NICOLE (HAS)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:NICOLE
Last Name:BOZEMAN
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 JUPITER LAKES BLVD.
Mailing Address - Street 2:BLDG. 3000 SUITE 202
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458
Mailing Address - Country:US
Mailing Address - Phone:561-744-0100
Mailing Address - Fax:561-744-0173
Practice Address - Street 1:210 JUPITER LAKES BLVD.
Practice Address - Street 2:BLDG. 3000 SUITE 202
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-744-0100
Practice Address - Fax:561-744-0173
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5195237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist