Individual
MRS. BONNIE LORETTA NORTHSEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED.
Contact information
Practice address
4117 NW 66TH TER, GAINESVILLE, FL 32606-4251
(352) 514-1772
Mailing address
4117 NW 66TH TER, GAINESVILLE, FL 32606-4251
(352) 514-1772
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/06/2009
Last updated
04/15/2019
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