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NPI Code Detail

MEDICARE: ROXIE LEE BONVILLE ARNP

MEDICARE: ROXIE LEE BONVILLE ARNP
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
1363LF0000XFamily Nurse PractitionerARNP2509322FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Y046EOTHERFLBLUE SHIELD

General Provider Information

NPI Number : 1972594356
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROXIE LEE BONVILLE ARNP
Provider Business Mailing Address
First Line : 981 37TH PL
Second Line :
City : VERO BEACH
State : FL
Zip : 32960-6541
Country : US
Telephone Number : 772-299-4255
Fax Number : 772-299-5380
Provider Business Practice Location Address
First Line : 981 37TH PL
Second Line :
City : VERO BEACH
State : FL
Zip : 32960-6541
Country : US
Telephone Number : 772-299-4255
Fax Number : 772-299-5380
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2005
Last Update Date : 07/08/2007

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Directions to “ ROXIE LEE BONVILLE ARNP” Practice Location

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