Provider Demographics
NPI:1073987715
Name:BONGIOVANNI, DELANA ALICIA (NP-C)
Entity Type:Individual
Prefix:
First Name:DELANA
Middle Name:ALICIA
Last Name:BONGIOVANNI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 REGINA DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-6368
Mailing Address - Country:US
Mailing Address - Phone:478-335-4558
Mailing Address - Fax:
Practice Address - Street 1:4585 HARTLEY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-5501
Practice Address - Country:US
Practice Address - Phone:478-781-9818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN192704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily