MEDICARE: SAMANTHA MARIA BONO PA-C

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	363A00000X	Physician Assistant	PA9106237	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FN731Z	OTHER	FL	MEDICARE

General Provider Information

NPI Number	:	1336424530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA MARIA BONO PA-C

Provider Business Mailing Address
First Line	:	4411 BEE RIDGE RD # 309
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34233-2514
Country	:	US
Telephone Number	:	419-266-5539
Fax Number	:	941-296-8501

Provider Business Practice Location Address
First Line	:	3105 BOBCAT VILLAGE CENTER RD
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-8974
Country	:	US
Telephone Number	:	941-271-0021
Fax Number	:	941-296-8501

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

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	08/02/2023

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