Provider Demographics
NPI:1851937395
Name:BONYNGE, HOLLY ROY (ARNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ROY
Last Name:BONYNGE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 COUNTY ROAD 125
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-7973
Mailing Address - Country:US
Mailing Address - Phone:352-551-0030
Mailing Address - Fax:
Practice Address - Street 1:2650 NW 2ND ST # 100
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-6234
Practice Address - Country:US
Practice Address - Phone:352-237-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1105061363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics