MEDICARE: MRS. MARVA LOUISE BENNETT-WILSON REGISTERED NURSE

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	164W00000X	Licensed Practical Nurse	PN5157934	FL
2	163W00000X	Registered Nurse	RN9389778	FL
3	251J00000X	Nursing Care Agency	RN9389778	FL
4	251E00000X	Home Health Agency
5	251F00000X	Home Infusion Agency
6	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578685186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARVA LOUISE BENNETT-WILSON REGISTERED NURSE

Provider Business Mailing Address
First Line	:	7188 S US #1
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952
Country	:	US
Telephone Number	:	772-301-1274
Fax Number	:	772-301-1387

Provider Business Practice Location Address
First Line	:	7188 S US #1
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952
Country	:	US
Telephone Number	:	772-301-1274
Fax Number	:	772-301-1387

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	05/03/2017

Similar Medicare Providers

1437783222 — HOLLY KELLY AMBROSE LCSW
Practice Location Address:

11 BRISA LN
PORT SAINT LUCIE, FL
34952-7920

Practice Phone: 331-210-4513
Practice Fax:

1457082455 — JULIANA BAKER RBT
Practice Location Address:

1801 SE HILLMOOR DR STE B101-103
PORT SAINT LUCIE, FL
34952-7553

Practice Phone: 561-676-6850
Practice Fax:

1720939366 — FRANTZ FORESTAL JR.
Practice Location Address:

10272 S US HIGHWAY 1
PORT SAINT LUCIE, FL
34952-5615

Practice Phone: 772-872-6940
Practice Fax:

1447102579 — PETER BLATTE
Practice Location Address:

9925 S US HIGHWAY 1 APT 108
PORT SAINT LUCIE, FL
34952-5636

Practice Phone: 561-762-0177
Practice Fax:

1376110056 — KATELYNN MARIE SMITH
Practice Location Address:

1801 SE HILLMOOR DR STE B101-103
PORT SAINT LUCIE, FL
34952-7553

Practice Phone: 772-463-0444
Practice Fax:

1194681528 — ROYAL PALM BEACH REHAB CORP
Practice Location Address:

10377 S US HIGHWAY 1 STE 101
PORT SAINT LUCIE, FL
34952-5630

Practice Phone: 772-497-0285
Practice Fax: 800-783-5176

1285586990 — SAVANNAH SIERRA TYAGI RN
Practice Location Address:

1881 SE TIFFANY AVE STE 306
PORT SAINT LUCIE, FL
34952-7567

Practice Phone: 772-335-9600
Practice Fax:

Directions to “ MRS. MARVA LOUISE BENNETT-WILSON REGISTERED NURSE” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.