Healthcare Provider Details

I. General information

NPI: 1255013629
Provider Name (Legal Business Name): LENNIS BEJARANO CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 VAN DYKE RD
LUTZ FL
33558-8005
US

IV. Provider business mailing address

1525 W CYPRESS CREEK RD
FORT LAUDERDALE FL
33309
US

V. Phone/Fax

Practice location:
  • Phone: 813-443-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA844
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: