Provider Demographics
NPI:1104836246
Name:TIEMANN, BONNIE FLEMING (ARNP)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:FLEMING
Last Name:TIEMANN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 N HABANA AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7112
Mailing Address - Country:US
Mailing Address - Phone:813-870-4460
Mailing Address - Fax:813-870-4459
Practice Address - Street 1:3554 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8402
Practice Address - Country:US
Practice Address - Phone:873-866-0930
Practice Address - Fax:727-321-3811
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP933502363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302281100Medicaid
FLS63390Medicare UPIN
FLE1220Medicare ID - Type UnspecifiedMEDICARE NUMBER