Provider Demographics
NPI:1629956479
Name:BLACKMAN, BONITA JODY (APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:BONITA
Middle Name:JODY
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 PULASKI HWY STE 167
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-1305
Mailing Address - Country:US
Mailing Address - Phone:302-373-8599
Mailing Address - Fax:
Practice Address - Street 1:1148 PULASKI HWY STE 167
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-1305
Practice Address - Country:US
Practice Address - Phone:302-373-8599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-21
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0010711363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health