Provider Demographics
NPI:1770632549
Name:CARINE, BONITA EMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:BONITA
Middle Name:EMES
Last Name:CARINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BONITA
Other - Middle Name:SUSAN
Other - Last Name:CARINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:JAMES A. HALEY VETERANS' HOSPITAL
Mailing Address - Street 2:13000 BRUCE B. DOWNS BLVD.
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612
Mailing Address - Country:US
Mailing Address - Phone:813-972-2000
Mailing Address - Fax:813-972-7673
Practice Address - Street 1:JAMES A. HALEY VETERANS' HOSPITAL
Practice Address - Street 2:13000 BRUCE B. DOWNS BLVD.
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:813-972-7673
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2009-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6154103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4761Medicare PIN