Healthcare Provider Details

I. General information

NPI: 1285675330
Provider Name (Legal Business Name): LORNA ODETTE BENNETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 CITRUS TOWER BLVD STE 104
CLERMONT FL
34711-6113
US

IV. Provider business mailing address

425 CITRUS TOWER BLVD STE 104
CLERMONT FL
34711-6113
US

V. Phone/Fax

Practice location:
  • Phone: 352-404-7728
  • Fax: 352-404-7724
Mailing address:
  • Phone: 352-404-7728
  • Fax: 352-404-7724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME91225
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: