Provider Demographics
NPI:1396058038
Name:TOLBERT, BONNIE ANN (NA/MA)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:ANN
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:NA/MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25101 NE 131ST PL
Mailing Address - Street 2:
Mailing Address - City:FORT MC COY
Mailing Address - State:FL
Mailing Address - Zip Code:32134-9300
Mailing Address - Country:US
Mailing Address - Phone:135-268-5618
Mailing Address - Fax:
Practice Address - Street 1:25101 NE 131ST PL
Practice Address - Street 2:
Practice Address - City:FORT MC COY
Practice Address - State:FL
Practice Address - Zip Code:32134-9300
Practice Address - Country:US
Practice Address - Phone:135-268-5618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X
FL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No376J00000XNursing Service Related ProvidersHomemaker