Basic Information
| Provider Information | |||||||||
| NPI: | 1427402932 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOGDANOWICZ | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LEAH | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5415 VERONA DR | ||||||||
| Address2: | APT A | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334372115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546475023 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7481 W OAKLAND PARK BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LAUDERHILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333194228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888526672 | ||||||||
| FaxNumber: | 3058916672 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2016 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN9251626 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.