Provider Demographics
NPI:1235246372
Name:LEVINE, BONNIE LOUISE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LOUISE
Last Name:LEVINE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:LOUISE
Other - Last Name:SEYMOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2699 STIRLING RD STE 301302A
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6517
Mailing Address - Country:US
Mailing Address - Phone:954-965-4922
Mailing Address - Fax:954-515-1184
Practice Address - Street 1:2699 STIRLING RD STE 301302A
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6517
Practice Address - Country:US
Practice Address - Phone:954-965-4922
Practice Address - Fax:954-515-1184
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3079802363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300917300Medicaid
FLE4161XMedicare UPIN
FL300917300Medicaid