Provider Demographics
NPI:1609184258
Name:SUNCOAST SURGICAL ASSISTING OF FL, INC.
Entity Type:Organization
Organization Name:SUNCOAST SURGICAL ASSISTING OF FL, INC.
Other - Org Name:SEAN D. BONNER, P.A.C., INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:352-796-2791
Mailing Address - Street 1:17362 PINTO LN.
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-9066
Mailing Address - Country:US
Mailing Address - Phone:352-796-2791
Mailing Address - Fax:352-686-7154
Practice Address - Street 1:17362 PINTO LN.
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34604-9066
Practice Address - Country:US
Practice Address - Phone:352-796-2791
Practice Address - Fax:352-686-7154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P62428Medicare UPIN