MEDICARE: BONEY K. MCGONE APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP60677454	WA
2	363LF0000X	Family Nurse Practitioner	APRN6983412	FL

General Provider Information

NPI Number	:	1154433597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONEY K. MCGONE APRN

Provider Business Mailing Address
First Line	:	1472 N HARBOR CITY BLVD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-6571
Country	:	US
Telephone Number	:	321-574-5376
Fax Number	:

Provider Business Practice Location Address
First Line	:	1472 N HARBOR CITY BLVD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-6571
Country	:	US
Telephone Number	:	321-574-5376
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/20/2022

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