Provider Demographics
NPI:1861535296
Name:COHEN, BONNI S (FNP)
Entity type:Individual
Prefix:DR
First Name:BONNI
Middle Name:S
Last Name:COHEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SAINT JOHNS COMMONS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4057
Mailing Address - Country:US
Mailing Address - Phone:904-635-7470
Mailing Address - Fax:
Practice Address - Street 1:137 DIEGO LANE
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-4057
Practice Address - Country:US
Practice Address - Phone:904-635-7470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201143363LA2200X
FLRN3061582363LF0000X
TXAP136780363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX382182901Medicaid
TX382182902OtherCSHCN