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General NPI Number Information
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NPI Number | 1174274575
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Entity Type | Individual
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Provider Name | JOHN BONSALL PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/17/2022
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 12902 USF MAGNOLIA DR
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City | TAMPA
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State | FL
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Zip | 33612-9416
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Country | US
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Telephone | 727-776-7239
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 198441
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City | ATLANTA
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State | GA
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Zip | 30384-8441
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Country | US
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Telephone | 813-745-7365
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Fax | 813-449-8618
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9119139
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License Number State | FL
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