Provider Demographics
NPI:1700513595
Name:BONILLA QUINONES, ANA BRISEIDA
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:BRISEIDA
Last Name:BONILLA QUINONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 SWALLOWTAIL DR
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-7740
Mailing Address - Country:US
Mailing Address - Phone:787-403-5512
Mailing Address - Fax:
Practice Address - Street 1:561 SWALLOWTAIL DR
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-7740
Practice Address - Country:US
Practice Address - Phone:787-403-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8436133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty