Healthcare Provider Details

I. General information

NPI: 1326974098
Provider Name (Legal Business Name): TAMMY BENNETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY JANSEN

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22395 EDGEWATER DR
PORT CHARLOTTE FL
33980-2012
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 941-766-7222
  • Fax: 866-504-5536
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2660942
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11048963
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: