Provider Demographics
NPI:1831507904
Name:BONNET, DESIREE LYNN (ARNP)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:LYNN
Last Name:BONNET
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 1:4444 E FLETCHER AVE STE C
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4905
Mailing Address - Country:US
Mailing Address - Phone:813-903-0060
Mailing Address - Fax:813-903-1773
Practice Address - Street 1:4444 E FLETCHER AVE STE C
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4905
Practice Address - Country:US
Practice Address - Phone:813-903-0060
Practice Address - Fax:813-903-1773
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9288421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013043600Medicaid
FLY0MU7OtherBLUE CROSS BLUE SHIELD
FLHX262ZMedicare PIN