Healthcare Provider Details

I. General information

NPI: 1083165674
Provider Name (Legal Business Name): M ELIZABETH BENNETT A.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3218 APOLLO TRL
TALLAHASSEE FL
32309-1902
US

IV. Provider business mailing address

3218 APOLLO TRL
TALLAHASSEE FL
32309-1902
US

V. Phone/Fax

Practice location:
  • Phone: 850-781-9888
  • Fax: 866-651-9711
Mailing address:
  • Phone: 850-781-9888
  • Fax: 866-651-9711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: