Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | APRN11006379 | FL |
NPI | 1013671858 |
---|---|
Provider Name | Haley Bonner |
First Address | Clermont, FL 34711-1979 |
Second Address | Clermont, FL 34711-1979 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2021 |
Last Update Date | 27/01/2022 |