Healthcare Provider Details

I. General information

NPI: 1821747395
Provider Name (Legal Business Name): APRN BENNETT HEALTH CARE , CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22570 SW 89TH PL
CUTLER BAY FL
33190-1332
US

IV. Provider business mailing address

22570 SW 89TH PL
CUTLER BAY FL
33190-1332
US

V. Phone/Fax

Practice location:
  • Phone: 786-797-8244
  • Fax: 786-701-3146
Mailing address:
  • Phone: 786-797-8244
  • Fax: 786-701-3146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARISOL BENNETT
Title or Position: PRESIDENT
Credential: APRN
Phone: 786-797-8244