NPIMap

Individual provider Active NPI

Bonita Joan Clark, APRN

  • Family Nurse Practitioner
  • St Petersburg, FL
National Provider Identifier
1639686363
Registry record updated May 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN11000995 Issued in FL
Practice address
1839 Central Ave
St Petersburg, FL 33713-8900
Phone
(727) 322-1054
Fax
(727) 821-7213
NPI assigned
Jan 3, 2018
Last updated
May 20, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN11000995 FL Primary

Addresses

Primary practice location

1839 Central Ave
St Petersburg, FL 33713-8900

Mailing address

1839 Central Ave
St Petersburg, FL 33713-8900
Phone (727) 322-1054

Other names 1

  • Bonita Joan Holloman Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220512001980 FL Practitioner - Nurse Practitioner 1153708151 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Professional Health Care of Pinellas, LLCGroup PAC ID 1658274675, 88 clinicians
H2 Rehabilitation Services of Florida LLCGroup PAC ID 3971411851, shared by 10 NPIs, 257 clinicians

Practice addresses (Care Compare)

1015 Golden Shiner Ave
Ruskin, FL 33570-3309
Phone (727) 656-6750

1839 Central Ave
St Petersburg, FL 33713-9089
Phone (727) 322-1054

6280 Central Ave
Suite H2
St Petersburg, FL 33707-1429
Phone (800) 699-9395

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Comprehensive Hospital Physicians of Florida Inc CurrentSince Mar 1, 2024 Accepting new patients
Mana Health Partners PA CurrentSince Dec 31, 2023 Accepting new patients
Abundant Harvest Health and Healing, LLC Family CurrentSince Nov 27, 2024 Accepting new patients
Professional Health Care of Pinellas Inc. CurrentSince May 10, 2022 Accepting new patients
Professional Health Care of Pinellas LLC CurrentSince May 10, 2022 Accepting new patients
Careconnectmd Florida P.a. CurrentSince Aug 1, 2024 Accepting new patients

Locations

3090 Bristol St
Ste 200
Costa Mesa, CA 92626
Phone (714) 992-1182

6020 Indiana Ave
New Prt Rchy, FL 34653
Phone (352) 860-0200

1317 Edgewater Dr
Orlando, FL 32804
Phone (877) 436-8527

1507 S Tuttle Ave
Sarasota, FL 34239
Phone (941) 366-0336

1839 Central Ave
St Petersburg, FL 33713
Phone (727) 322-1054

4905 34th St S
St Petersburg, FL 33711
Phone (727) 342-0209

5500 Mlk Jr St N
St Petersburg, FL 33703
Phone (727) 525-5500

7101 Mlk Jr St N
St Petersburg, FL 33702
Phone (727) 527-7231

338 Whitesville Rd
Ste 103
Jackson, NJ 08527

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EIJHAA

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1514937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653004800000",
    "number": "1639686363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1839 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337138900",
            "telephone_number": "727-322-1054",
            "fax_number": "727-821-7213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1839 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337138900",
            "telephone_number": "727-322-1054",
            "fax_number": "727-821-7213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BONITA",
        "middle_name": "JOAN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-03",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11000995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BONITA",
            "last_name": "HOLLOMAN",
            "middle_name": "JOAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.