Healthcare Provider Details

I. General information

NPI: 1346040714
Provider Name (Legal Business Name): MARIA BENNETT MSN-APRN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2025
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 ELDRON BLVD SE
PALM BAY FL
32909-8517
US

IV. Provider business mailing address

2338 KENNINGTON CV
DELAND FL
32724-8471
US

V. Phone/Fax

Practice location:
  • Phone: 321-497-6744
  • Fax:
Mailing address:
  • Phone: 646-408-5897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15424000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11038202
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: