Provider Demographics
NPI:1689391559
Name:HALL, BONNIECIEL M (APRN)
Entity Type:Individual
Prefix:
First Name:BONNIECIEL
Middle Name:M
Last Name:HALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BONNIECIEL
Other - Middle Name:M
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, APRN, FNP-C
Mailing Address - Street 1:25097 NW BATES RD
Mailing Address - Street 2:
Mailing Address - City:ALTHA
Mailing Address - State:FL
Mailing Address - Zip Code:32421-2637
Mailing Address - Country:US
Mailing Address - Phone:850-209-3588
Mailing Address - Fax:
Practice Address - Street 1:25097 NW BATES RD
Practice Address - Street 2:
Practice Address - City:ALTHA
Practice Address - State:FL
Practice Address - Zip Code:32421-2637
Practice Address - Country:US
Practice Address - Phone:850-209-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily