Bonomo, Brian Keith

Bonomo, Brian Keith is an individual health care provider with primary practice located at 525 N Dacie Pt , Lecanto FL 34461-8399. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Bonomo, Brian Keith can be contacted via phone (352) 746-2200.

Contact Information

Primary practice address
525 N Dacie Pt Lecanto FL 34461-8399
Phone: (352) 746-2200
Fax: (352) 746-9320
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA9101264 Florida

Profile Details

NPI number 1124012596
LBN Legal business name Bonomo, Brian Keith
Credentials PAC
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2005
Last updated Nov 12th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124012596 NPPES
Florida Other 970015048 SRRGA
Florida MEDICAID 290989800 SRRGA

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