Provider Demographics
NPI:1255320446
Name:NESTLER, BONNIE M (ARNP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:M
Last Name:NESTLER
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 1:8220 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6639
Mailing Address - Country:US
Mailing Address - Phone:727-841-8505
Mailing Address - Fax:727-846-0561
Practice Address - Street 1:8220 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6639
Practice Address - Country:US
Practice Address - Phone:727-841-8505
Practice Address - Fax:727-846-0561
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1939852207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302746501Medicaid
FL302746501Medicaid
S74518Medicare UPIN