MEDICARE: BENITA CULLINS FORD ARNP

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	363LF0000X	Family Nurse Practitioner	ARNP2750572	FL

General Provider Information

NPI Number	:	1285678235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENITA CULLINS FORD ARNP

Provider Business Mailing Address
First Line	:	12502 LOCHLOOSA LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-2343
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4266 SUNBEAM RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-6030
Country	:	US
Telephone Number	:	904-874-0779
Fax Number	:

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	09/06/2007

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