Provider Demographics
NPI:1770803520
Name:BOBO, MARIE ASTRIDE (APRN)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ASTRIDE
Last Name:BOBO
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 1:123 NW 109TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33168-4316
Mailing Address - Country:US
Mailing Address - Phone:305-761-2083
Mailing Address - Fax:
Practice Address - Street 1:123 NW 109TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33168-4316
Practice Address - Country:US
Practice Address - Phone:305-761-2083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3105032363LF0000X
FL231573376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily