Healthcare Provider Details

I. General information

NPI: 1992131080
Provider Name (Legal Business Name): BENNETT PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 CITRUS TOWER 5 BLVD APT 104
CLERMONT FL
34711
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: DR. LORNA BENNETT
Title or Position: OWNER/PEDIATRICIAN
Credential: M.D.,
Phone: 352-978-3182