Healthcare Provider Details

I. General information

NPI: 1871760199
Provider Name (Legal Business Name): BONNIE R SAKS MD AND ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W KENNEDY BLVD SUITE 106
TAMPA FL
33609-2976
US

IV. Provider business mailing address

3333 W KENNEDY BLVD SUITE 106
TAMPA FL
33609-2976
US

V. Phone/Fax

Practice location:
  • Phone: 813-354-9444
  • Fax: 813-354-9436
Mailing address:
  • Phone: 813-354-9444
  • Fax: 813-354-9436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberARNP2603542
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberARNP318832
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMH0002956
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberSW768
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberSW782
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberSW9045
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberME0039891
License Number StateFL

VIII. Authorized Official

Name: DR. BONNIE R SAKS
Title or Position: MEMBER
Credential: MD
Phone: 813-354-9444