MEDICARE: BENITA SUZETTE CORBITT-CHERRY 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	363LW0102X	Women's Health Nurse Practitioner	ARNP3028282	FL

General Provider Information

NPI Number	:	1962410720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENITA SUZETTE CORBITT-CHERRY ARNP

Provider Business Mailing Address
First Line	:	515 W 6TH ST
Second Line	:	MC #24
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-4324
Country	:	US
Telephone Number	:	904-665-2410
Fax Number	:	904-630-3316

Provider Business Practice Location Address
First Line	:	2133 BROADWAY AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-7513
Country	:	US
Telephone Number	:	904-665-2650
Fax Number	:	904-665-1789

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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