=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336539170
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BONNIE ZONAS MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2015
-----------------------------------------------------
Last Update Date | 07/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 680 2ND AVE N SUITE 301
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-5753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-261-7546
-----------------------------------------------------
Fax | 239-261-1522
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 680 2ND AVE N SUITE 301
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-5753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-261-7546
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MATTHEW WAGNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-940-2468
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207NS0135X
-----------------------------------------------------
Taxonomy Name | Procedural Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------