=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932860830
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL FRANK BONADEO APRN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2022
-----------------------------------------------------
Last Update Date | 05/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3889 MILITARY TRL STE 103
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33458-2923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-468-2370
-----------------------------------------------------
Fax | 561-566-1884
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12256 157TH ST N
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33478-6664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-818-7677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11012967
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------