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General NPI Number Information
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NPI Number | 1265664239
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Entity Type | Individual
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Provider Name | PAULA JEAN BONSER COTA/L
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Gender | Female
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 08/10/2009
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Provider Practice Location Address
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Address Line | 725 DESOTO AVE
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City | BROOKSVILLE
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State | FL
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Zip | 34601-2813
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Country | US
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Telephone | 352-593-4128
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Fax |
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Provider Business Mailing Address
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Address Line | 18443 MOORHAVEN DR
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City | SPRING HILL
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State | FL
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Zip | 34610-7118
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Country | US
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Telephone | 352-797-9996
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | OTA9260
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License Number State | FL
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