Individual
JUDITH JOSE BONIFACIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN, CPNP-PC
Contact information
Practice address
1500 W ROSEDALE ST, FORT WORTH, TX 76104-7403
(682) 885-3426
(682) 885-7699
Mailing address
PO BOX 733784, DALLAS, TX 75373-3784
(682) 885-6483
(682) 885-3113
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
AP138755
TX
363LP2300X
Primary Care Nurse Practitioner
Primary
AP138755
TX
Other
Enumeration date
12/10/2018
Last updated
10/16/2023
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