Provider Demographics
NPI:1356349344
Name:SKUKOWSKI, BOBBIE M (ARNP)
Entity type:Individual
Prefix:
First Name:BOBBIE
Middle Name:M
Last Name:SKUKOWSKI
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:BOND CLINIC, P.A.
Mailing Address - Street 2:500 EAST CENTRAL AVENUE
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880
Mailing Address - Country:US
Mailing Address - Phone:863-293-1191
Mailing Address - Fax:863-293-3635
Practice Address - Street 1:BOND CLINIC, P.A.
Practice Address - Street 2:199 AVE. B., N.W.
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881
Practice Address - Country:US
Practice Address - Phone:863-293-1191
Practice Address - Fax:863-508-2213
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP-1186752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3015530-00Medicaid
FLS17995Medicare UPIN