Healthcare Provider Details

I. General information

NPI: 1255605440
Provider Name (Legal Business Name): BONNIE BLANK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 SW 77TH ST
MIAMI FL
33143-6053
US

IV. Provider business mailing address

4920 SW 77TH ST
MIAMI FL
33143-6053
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-6511
  • Fax: 305-669-6438
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberARNP3351907
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: