Healthcare Provider Details

I. General information

NPI: 1316556590
Provider Name (Legal Business Name): LAUREN MARIE BENTLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6802 BISHOPS POINTE WAY
RIVERVIEW FL
33578-8387
US

IV. Provider business mailing address

6802 BISHOPS POINTE WAY
RIVERVIEW FL
33578-8387
US

V. Phone/Fax

Practice location:
  • Phone: 407-489-5111
  • Fax:
Mailing address:
  • Phone: 407-489-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: