MEDICARE: ALICIA MARIE BENNETT RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	APRN11031454	FL
2	367500000X	Certified Registered Nurse Anesthetist	558398	KS

General Provider Information

NPI Number	:	1063082154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA MARIE BENNETT RN

Provider Business Mailing Address
First Line	:	3533 NW 37TH AVE
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-5330
Country	:	US
Telephone Number	:	954-842-9778
Fax Number	:

Provider Business Practice Location Address
First Line	:	3533 NW 37TH AVE
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-5330
Country	:	US
Telephone Number	:	954-842-9778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	06/08/2026

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