Provider Demographics
NPI:1093355562
Name:BONILLA, ODANIA (APRN)
Entity Type:Individual
Prefix:
First Name:ODANIA
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4385 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7628
Mailing Address - Country:US
Mailing Address - Phone:305-824-0637
Mailing Address - Fax:305-824-0628
Practice Address - Street 1:4385 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7628
Practice Address - Country:US
Practice Address - Phone:305-824-0637
Practice Address - Fax:305-824-0628
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9428234163W00000X
FLAPRN11019563363L00000X, 363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9428234OtherLICENSE