Provider Demographics
NPI:1245059146
Name:BOHORQUEZ, BELEN A (PA)
Entity type:Individual
Prefix:
First Name:BELEN
Middle Name:A
Last Name:BOHORQUEZ
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 TREADWAY DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-7941
Mailing Address - Country:US
Mailing Address - Phone:407-818-3154
Mailing Address - Fax:
Practice Address - Street 1:2723 SE MARICAMP RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5537
Practice Address - Country:US
Practice Address - Phone:352-732-7779
Practice Address - Fax:352-732-2664
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLPAT9119732363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program