1336424530 NPI number — SAMANTHA MARIA BONO PA-C

Table of content: CINDY K HERNANDEZ M.D. (NPI 1093057259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336424530 NPI number — SAMANTHA MARIA BONO PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONO
Provider First Name:
SAMANTHA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336424530
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3105 BOBCAT VILLAGE CENTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PORT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34288-8974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-271-0021
Provider Business Practice Location Address Fax Number:
941-296-8501
Provider Enumeration Date:
10/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA9106237 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FN731Z . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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