Individual
EDMUND BONGOLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
701 N WEST SHORE BLVD, TAMPA, FL 33609-1122
(813) 533-7080
Mailing address
5204 HAMPTON BEACH PL, TAMPA, FL 33609-2498
(813) 732-1749
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP9310211
FL
Other
Enumeration date
07/30/2017
Last updated
08/20/2020
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