MEDICARE: BONNY MICHELLE ABERNATHY APRN

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	363L00000X	Nurse Practitioner	APRN11016579	FL
2	363LF0000X	Family Nurse Practitioner	APRN11016579	FL

General Provider Information

NPI Number	:	1750036224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNY MICHELLE ABERNATHY APRN

Provider Business Mailing Address
First Line	:	3653 SHAWNEE SHORES DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-4302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3653 SHAWNEE SHORES DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-4302
Country	:	US
Telephone Number	:	904-386-9680
Fax Number	:

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

Provider Enumeration Date	:	02/14/2022
Last Update Date	:	12/04/2025

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