Healthcare Provider Details

I. General information

NPI: 1881685758
Provider Name (Legal Business Name): EVELYN SUSANNE BENGSTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18743 NW 234TH ST
HIGH SPRINGS FL
32643-0465
US

IV. Provider business mailing address

18743 NW 234TH ST
HIGH SPRINGS FL
32643-0465
US

V. Phone/Fax

Practice location:
  • Phone: 386-454-0721
  • Fax: 386-454-0722
Mailing address:
  • Phone: 386-454-0721
  • Fax: 386-454-0722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP2209102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: