Provider Demographics
NPI:1083680219
Name:SCOTT, BONNIE SUE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:SUE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 NIDER BLVD SUITE 100
Mailing Address - Street 2:JEB LITTLE CREEK FORT STORY
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23459-3512
Mailing Address - Country:US
Mailing Address - Phone:757-953-8365
Mailing Address - Fax:
Practice Address - Street 1:1035 NIDER BLVD SUITE 199
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23459-2731
Practice Address - Country:US
Practice Address - Phone:757-953-8365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily