Provider Demographics
NPI:1962100594
Name:BONILLA, SILVIA SOLEDAD (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SILVIA
Middle Name:SOLEDAD
Last Name:BONILLA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2282 COUNTY ROAD 332
Mailing Address - Street 2:
Mailing Address - City:ERA
Mailing Address - State:TX
Mailing Address - Zip Code:76238-2801
Mailing Address - Country:US
Mailing Address - Phone:940-595-2372
Mailing Address - Fax:
Practice Address - Street 1:2809 S MAYHILL RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-5910
Practice Address - Country:US
Practice Address - Phone:940-239-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1111490363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty