Provider Demographics
NPI:1083057624
Name:MACQUEEN, BONNI LYNN (APN)
Entity Type:Individual
Prefix:
First Name:BONNI
Middle Name:LYNN
Last Name:MACQUEEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25225 LOST OAK CIR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7400
Mailing Address - Country:US
Mailing Address - Phone:609-781-2802
Mailing Address - Fax:
Practice Address - Street 1:33041 PROFESSIONAL DR STE 101
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3761
Practice Address - Country:US
Practice Address - Phone:352-478-0010
Practice Address - Fax:949-577-4163
Is Sole Proprietor?:No
Enumeration Date:2013-04-13
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9492848363LA2200X
NJ26NJ00429200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health