Provider Demographics
NPI:1447971734
Name:BOHNER, JONATHAN DAVID (PA-C)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DAVID
Last Name:BOHNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 BRANDY OAKS LOOP
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2439
Mailing Address - Country:US
Mailing Address - Phone:407-506-7844
Mailing Address - Fax:
Practice Address - Street 1:400 CELEBRATION PL STE A290
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4970
Practice Address - Country:US
Practice Address - Phone:407-303-3827
Practice Address - Fax:407-303-3828
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116306363A00000X
FL9116306208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208600000XAllopathic & Osteopathic PhysiciansSurgery