Provider Demographics
NPI:1578269627
Name:PRAUGHT, BONNIE TAYLOR (FNP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:TAYLOR
Last Name:PRAUGHT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 TROON WAY
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-2601
Mailing Address - Country:US
Mailing Address - Phone:870-844-0725
Mailing Address - Fax:
Practice Address - Street 1:66 BOVET RD STE 105
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3126
Practice Address - Country:US
Practice Address - Phone:650-288-0826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR222020363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner