Provider Demographics
NPI:1225671886
Name:BONILLA, PAIGE (APRN)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:VALLELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3432 HARBOR LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-4242
Mailing Address - Country:US
Mailing Address - Phone:636-541-2633
Mailing Address - Fax:
Practice Address - Street 1:2675 TAMPA RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3109
Practice Address - Country:US
Practice Address - Phone:727-586-4432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003749363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care