Provider Demographics
NPI:1205988243
Name:BOZZA, JENNIFER (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BOZZA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9558 DONATION RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16441-4264
Mailing Address - Country:US
Mailing Address - Phone:814-602-0190
Mailing Address - Fax:
Practice Address - Street 1:126 CORNISH ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:NY
Practice Address - Zip Code:14781-9791
Practice Address - Country:US
Practice Address - Phone:716-761-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily