Provider Demographics
NPI:1114337789
Name:POLYCARPE BONHOMME, MARTINE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARTINE
Middle Name:
Last Name:POLYCARPE BONHOMME
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:MARTINE
Other - Middle Name:
Other - Last Name:BONHOMME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:954-439-4833
Mailing Address - Fax:954-432-7682
Practice Address - Street 1:16269 SW 21ST STREET
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027
Practice Address - Country:US
Practice Address - Phone:954-439-4833
Practice Address - Fax:954-432-7682
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2810312363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner