Provider Demographics
NPI:1245573609
Name:NONNEMAKER, SEAN (DO)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:NONNEMAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 2ND ST E
Mailing Address - Street 2:STE 3B
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1029
Mailing Address - Country:US
Mailing Address - Phone:941-746-4151
Mailing Address - Fax:941-746-4345
Practice Address - Street 1:250 2ND ST E
Practice Address - Street 2:STE 3B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1029
Practice Address - Country:US
Practice Address - Phone:941-746-4151
Practice Address - Fax:941-746-4345
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12880207R00000X, 208M00000X
FLUO3704207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD64Q7OtherBLUE CROSS
FL019190200Medicaid