Individual
BONNIE L. GRUNDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
369 N MAIN ST, CRESTVIEW, FL 32536-3541
(850) 398-6963
(850) 398-8277
Mailing address
550 REDSTONE AVE W STE 490, CRESTVIEW, FL 32536-6457
(850) 689-8321
(850) 689-8322
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9101053
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123872 CRESTVIEW
—
AL
05
—
123873 SANTA ROSA
—
AL
01
—
17667
HEALTH FIRST NETWORK
FL
05
—
291926500
—
FL
01
—
P00900587
RAILROAD MCR
FL
01
—
P931666
OPTIMUM
FL
01
—
P986780
FREEDOM HEALTH
FL
01
—
Y015K
BLUE CROSS BLUE SHIELD
FL
Enumeration date
03/14/2006
Last updated
09/08/2020
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