Healthcare Provider Details

I. General information

NPI: 1417501503
Provider Name (Legal Business Name): NORMA LORENA BONILLA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2019
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FORT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

15345 SW 163RD ST
MIAMI FL
33187-1412
US

V. Phone/Fax

Practice location:
  • Phone: 954-355-4400
  • Fax: 954-355-5872
Mailing address:
  • Phone: 305-546-8467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAPRN11002562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: