Healthcare Provider Details

I. General information

NPI: 1750358917
Provider Name (Legal Business Name): SANDRA E BENTER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W PROSPECT RD
FORT LAUDERDALE FL
33309-2519
US

IV. Provider business mailing address

4740 N STATE ROAD 7 STE 201
LAUDERDALE LAKES FL
33319-5839
US

V. Phone/Fax

Practice location:
  • Phone: 954-731-1000
  • Fax: 954-497-3857
Mailing address:
  • Phone: 954-486-4005
  • Fax: 954-497-3857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberARNP3137982
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP3137982
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: