Doctor Name: | SAMANTHA BONILLA |
NPI Number: | 1174978175 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP |
License Number: | 9226889 |
Business Practice Address: | 2254 Blackwood Dr Mulberry, FL - 338605500 |
Business Phone Number: | 8634091854 |
Business Fax Number: | |
Mailing Address: | 2254 Blackwood Dr, MULBERRY |
State: | FL |
Postal Code: | 338605500 |
Phone Number: | 8634091854 |
Fax Number: | |
NPI Enumeration Date: | 04/27/2016 |
NPI Last Update Date: | 04/27/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LG0600X |
License Number: | 9226889 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Gerontology |
Taxonomy Definition: |