Provider Demographics
NPI:1437945136
Name:HERNANDEZ BONILLA, AMELIA IGNACIA
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:IGNACIA
Last Name:HERNANDEZ BONILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:HERNANDEZ BONILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10451 W BROWARD BLVD APT 109
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2125
Mailing Address - Country:US
Mailing Address - Phone:954-661-4931
Mailing Address - Fax:
Practice Address - Street 1:10451 W BROWARD BLVD APT 109
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2125
Practice Address - Country:US
Practice Address - Phone:954-661-4931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11038851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily