Provider Demographics
NPI:1730764309
Name:BOUZA ARJONA, LILIANA (APRN)
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:BOUZA ARJONA
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 1:302 NE JONQUIL ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1762
Mailing Address - Country:US
Mailing Address - Phone:772-579-6259
Mailing Address - Fax:
Practice Address - Street 1:683 SW PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-1998
Practice Address - Country:US
Practice Address - Phone:772-204-2909
Practice Address - Fax:772-785-8138
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012073363LF0000X
FLF02211032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113418600Medicaid