Provider Demographics
NPI:1801956677
Name:HARKINS, BONITA S (FNP)
Entity type:Individual
Prefix:MRS
First Name:BONITA
Middle Name:S
Last Name:HARKINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13761 COLUMBINE ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-7250
Mailing Address - Country:US
Mailing Address - Phone:720-732-0223
Mailing Address - Fax:303-659-4453
Practice Address - Street 1:10465 MELODY DR
Practice Address - Street 2:# 306
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234
Practice Address - Country:US
Practice Address - Phone:303-450-8214
Practice Address - Fax:303-450-8218
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO109556163W00000X
CO4087363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26302268Medicaid
COFRA618006OtherBC-BS-GROUP
CO26302268Medicaid
COQ62792Medicare UPIN
COC804527Medicare ID - Type UnspecifiedMEDICARE-INDIVIDUAL