MEDICARE: LINDA BARNES-BONNEAU LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN5174312	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427674530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA BARNES-BONNEAU LPN

Provider Business Mailing Address
First Line	:	4534 13TH AVE S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33711-2409
Country	:	US
Telephone Number	:	727-482-7256
Fax Number	:

Provider Business Practice Location Address
First Line	:	4534 13TH AVE S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33711-2409
Country	:	US
Telephone Number	:	727-482-7256
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	06/24/2020

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