Healthcare Provider Details

I. General information

NPI: 1033672407
Provider Name (Legal Business Name): NANCY FRANCES BENT ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 PASEO REYES DR
ST AUGUSTINE FL
32095-8464
US

IV. Provider business mailing address

8788 TOWNSQUARE CT
JACKSONVILLE FL
32216-0509
US

V. Phone/Fax

Practice location:
  • Phone: 904-318-6109
  • Fax:
Mailing address:
  • Phone: 904-566-0169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16800
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: