Provider Demographics
NPI:1740793215
Name:BRONFENBRENER, TONI (CRNP)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:BRONFENBRENER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:
Other - Last Name:LIND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1122 STREET RD STE 2044218
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4218
Mailing Address - Country:US
Mailing Address - Phone:215-999-7546
Mailing Address - Fax:215-608-6008
Practice Address - Street 1:1122 STREET RD STE 2044218
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4218
Practice Address - Country:US
Practice Address - Phone:215-999-7546
Practice Address - Fax:215-608-6008
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017484363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner