Healthcare Provider Details

I. General information

NPI: 1235246372
Provider Name (Legal Business Name): BONNIE LOUISE LEVINE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BONNIE LOUISE SEYMOUR ARNP

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2699 STIRLING RD STE 301302A
FORT LAUDERDALE FL
33312-6517
US

IV. Provider business mailing address

2699 STIRLING RD STE 301302A
FORT LAUDERDALE FL
33312-6517
US

V. Phone/Fax

Practice location:
  • Phone: 954-965-4922
  • Fax: 954-515-1184
Mailing address:
  • Phone: 954-965-4922
  • Fax: 954-515-1184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number3079802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: