Provider Demographics
NPI:1700625605
Name:BONILLA, EVELIN Y (HOME HEALTH AIDE)
Entity type:Individual
Prefix:
First Name:EVELIN
Middle Name:Y
Last Name:BONILLA
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 CROSSING BLVD APT 128
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-6224
Mailing Address - Country:US
Mailing Address - Phone:954-914-4027
Mailing Address - Fax:
Practice Address - Street 1:351 CROSSING BLVD APT 128
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-6224
Practice Address - Country:US
Practice Address - Phone:954-914-4027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide