Provider Demographics
NPI:1861030660
Name:BOUZA, DIANELIS (APRN)
Entity Type:Individual
Prefix:
First Name:DIANELIS
Middle Name:
Last Name:BOUZA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12389 NW 98TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-2961
Mailing Address - Country:US
Mailing Address - Phone:786-953-2139
Mailing Address - Fax:
Practice Address - Street 1:21110 BISCAYNE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1228
Practice Address - Country:US
Practice Address - Phone:305-932-1007
Practice Address - Fax:305-696-6225
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004426363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily