Individual provider Active NPI

Bonnie Westphal, PA-C

  • Physician Assistant
  • Tampa, FL
National Provider Identifier
1699424606
Registry record updated Sep 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9115525 Issued in FL
Practice address
405 S Dale Mabry Hwy # 362
Tampa, FL 33609-2820
Phone
(813) 582-5823
NPI assigned
Mar 18, 2022
Last updated
Sep 16, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 16, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X PA9115525 FL Primary

Addresses

Primary practice location

405 S Dale Mabry Hwy # 362
Tampa, FL 33609-2820

Mailing address

405 S Dale Mabry Hwy # 362
Tampa, FL 33609-2820
Phone (813) 582-5823

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PA9115525FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Imad Al-Nakshabendi M D P a Single Specialty CurrentSince Mar 20, 2022 Accepting new patients

Locations

671 S Kings Ave
Brandon, FL 33511
Phone (813) 972-3750

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1647561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789516800000",
    "number": "1699424606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 S DALE MABRY HWY # 362",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336092820",
            "telephone_number": "813-582-5823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 S DALE MABRY HWY # 362",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336092820",
            "telephone_number": "813-582-5823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WESTPHAL",
        "first_name": "BONNIE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-18",
        "last_updated": "2026-09-16",
        "certification_date": "2026-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9115525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.