Provider Demographics
NPI:1578029120
Name:SEARS PRADO, BONNIE ANN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:ANN
Last Name:SEARS PRADO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 BLUE BELL DR
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-7111
Mailing Address - Country:US
Mailing Address - Phone:817-913-8665
Mailing Address - Fax:
Practice Address - Street 1:15 NORTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-3764
Practice Address - Country:US
Practice Address - Phone:843-681-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21886363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily