Provider Demographics
NPI:1609024629
Name:WILLIAMS, BONITA S (MNT)
Entity Type:Individual
Prefix:MS
First Name:BONITA
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-532-1355
Mailing Address - Fax:813-635-2613
Practice Address - Street 1:430 PINELLAS ST STE 400
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3365
Practice Address - Country:US
Practice Address - Phone:727-461-8300
Practice Address - Fax:813-635-2187
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4886133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00726956OtherRAILROAD MEDICARE PROVIDER NUMBER
FLAQ128ZMedicare PIN
FLAQ128YMedicare PIN