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General NPI Number Information
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NPI Number | 1104030212
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Entity Type | Individual
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Provider Name | MARIA EVERSOLE BONNETT A.R.N.P.
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Gender | Female
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2 SUNTREE PL
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City | MELBOURNE
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State | FL
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Zip | 32940-7689
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Country | US
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Telephone | 321-259-1883
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Fax |
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Provider Business Mailing Address
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Address Line | 305 JACALA DR
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-3169
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Country | US
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Telephone | 321-453-8888
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP1622702
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License Number State | FL
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