Provider Demographics
NPI:1134886054
Name:BOYCHEV, MARIYA
Entity type:Individual
Prefix:
First Name:MARIYA
Middle Name:
Last Name:BOYCHEV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 RAMSGATE PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6858
Mailing Address - Country:US
Mailing Address - Phone:386-627-6069
Mailing Address - Fax:
Practice Address - Street 1:1400 HAND AVE STE I
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8195
Practice Address - Country:US
Practice Address - Phone:386-673-0517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-27
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11028420363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner