Provider Demographics
NPI:1649608845
Name:BONAROTI, CARRIE NOGUEIRA (MD)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:NOGUEIRA
Last Name:BONAROTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 S BENEVA RD STE 306
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2499
Mailing Address - Country:US
Mailing Address - Phone:941-955-1108
Mailing Address - Fax:941-954-4440
Practice Address - Street 1:943 S BENEVA RD STE 204
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2472
Practice Address - Country:US
Practice Address - Phone:419-535-2139
Practice Address - Fax:941-953-3087
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045040L207Q00000X
FLME136264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD045040LOtherPA STATE LICENSE
PAMD045040LOtherPA STATE LICENSE