Healthcare Provider Details

I. General information

NPI: 1700518735
Provider Name (Legal Business Name): ALEXIS HERNANDEZ BONILLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13438 FORT KING RD
DADE CITY FL
33525-5214
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 352-567-5266
  • Fax: 352-567-3066
Mailing address:
  • Phone: 727-322-3439
  • Fax: 800-928-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1449
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number22808
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: