Provider Demographics
NPI:1548501745
Name:CULPA-BONDAL, MARIA FLORDESOL ABULOC (RN, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:MARIA FLORDESOL
Middle Name:ABULOC
Last Name:CULPA-BONDAL
Suffix:
Gender:F
Credentials:RN, PMHNP-BC
Other - Prefix:DR
Other - First Name:FLOR
Other - Middle Name:
Other - Last Name:BONDAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, PMHNP-BC
Mailing Address - Street 1:145 STONE BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-5864
Mailing Address - Country:US
Mailing Address - Phone:478-986-2776
Mailing Address - Fax:
Practice Address - Street 1:145 STONE BROOKE DR
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-5864
Practice Address - Country:US
Practice Address - Phone:478-986-2776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN109284364SP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN109284OtherCLINICAL NURSE SPECIALIST - PMHCNS