Provider Demographics
NPI:1265728075
Name:RAMBO, BONITA D (CRNA)
Entity type:Individual
Prefix:
First Name:BONITA
Middle Name:D
Last Name:RAMBO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BONITA
Other - Middle Name:D
Other - Last Name:RAMBO-SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 850001
Mailing Address - Street 2:DEPT #0753
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0753
Mailing Address - Country:US
Mailing Address - Phone:352-259-3814
Mailing Address - Fax:
Practice Address - Street 1:3710 LAKE CENTER DR
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2316
Practice Address - Country:US
Practice Address - Phone:352-383-1268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3115212367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered