Provider Demographics
NPI:1093249724
Name:PAUL BOND, LLC
Entity Type:Organization
Organization Name:PAUL BOND, LLC
Other - Org Name:BESPOKE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:386-986-6469
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-0957
Mailing Address - Country:US
Mailing Address - Phone:386-986-6469
Mailing Address - Fax:386-437-6969
Practice Address - Street 1:704 E MOODY BLVD
Practice Address - Street 2:UNIT 957
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-5922
Practice Address - Country:US
Practice Address - Phone:386-986-6469
Practice Address - Fax:386-437-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2730962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty