Healthcare Provider Details

I. General information

NPI: 1225636434
Provider Name (Legal Business Name): TOCCARA S BENNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 RYWOOD DR
ORLANDO FL
32810-6610
US

IV. Provider business mailing address

5721 RYWOOD DR
ORLANDO FL
32810-6610
US

V. Phone/Fax

Practice location:
  • Phone: 407-371-1550
  • Fax:
Mailing address:
  • Phone: 407-371-1550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: