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NPI Code Detail

MEDICARE: SAMANTHA BONILLA APRN

MEDICARE: SAMANTHA BONILLA 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
1363LP2300XPrimary Care Nurse PractitionerAPRN9226889FL
2363LA2200XAdult Health Nurse PractitionerAPRN9226889FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174978175
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA BONILLA APRN
Provider Business Mailing Address
First Line : 4915 EHRLICH RD
Second Line :
City : TAMPA
State : FL
Zip : 33624-2038
Country : US
Telephone Number : 813-591-4570
Fax Number : 813-591-4570
Provider Business Practice Location Address
First Line : 4915 EHRLICH RD
Second Line :
City : TAMPA
State : FL
Zip : 33624-2038
Country : US
Telephone Number : 813-591-4570
Fax Number : 813-591-4570
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2016
Last Update Date : 02/10/2025

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Directions to “ SAMANTHA BONILLA APRN” Practice Location

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