Provider Demographics
NPI:1164845467
Name:BONA, JENNIFER (BA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BONA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 S DALE MABRY HWY
Mailing Address - Street 2:STE. 201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5019
Mailing Address - Country:US
Mailing Address - Phone:813-258-8887
Mailing Address - Fax:813-925-4351
Practice Address - Street 1:1220 S DALE MABRY HWY
Practice Address - Street 2:STE. 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5019
Practice Address - Country:US
Practice Address - Phone:813-258-8887
Practice Address - Fax:813-925-4351
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011807700Medicaid