Individual
CASEY RENEE BONAQUIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
836 PRUDENTIAL DR STE 1006, JACKSONVILLE, FL 32207-8337
(904) 202-1795
(904) 376-3478
Mailing address
PO BOX 746647, ATLANTA, GA 30374-6647
(904) 202-2092
(904) 376-4075
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OS12248
FL
207QB0002X
Obesity Medicine (Family Medicine) Physician
Primary
OS12248
FL
Other
Enumeration date
06/27/2008
Last updated
08/15/2025
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