Healthcare Provider Details

I. General information

NPI: 1699424606
Provider Name (Legal Business Name): BONNIE WESTPHAL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S DALE MABRY HWY # 362
TAMPA FL
33609-2820
US

IV. Provider business mailing address

405 S DALE MABRY HWY # 362
TAMPA FL
33609-2820
US

V. Phone/Fax

Practice location:
  • Phone: 813-582-5823
  • Fax:
Mailing address:
  • Phone: 813-582-5823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9115525
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: