Basic Information
Provider Information
NPI: 1710558440
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BUONO
FirstName: JUDITH
MiddleName: PATRICIA
NamePrefix:  
NameSuffix:  
Credential: APRN-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 38135 MARKET SQUARE DR
Address2:  
City: ZEPHYRHILLS
State: FL
PostalCode: 335427539
CountryCode: US
TelephoneNumber: 8137887651
FaxNumber: 8133555021
Practice Location
Address1: 38135 MARKET SQUARE DR STE 100
Address2:  
City: ZEPHYRHILLS
State: FL
PostalCode: 335427539
CountryCode: US
TelephoneNumber: 8137887651
FaxNumber: 8133555021
Other Information
ProviderEnumerationDate: 07/04/2021
LastUpdateDate: 07/13/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/13/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN11014021FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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