Healthcare Provider Details

I. General information

NPI: 1306589767
Provider Name (Legal Business Name): DANA BENTLEY ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/14/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12308 COUNTRY WHITE CIR
TAMPA FL
33635-6280
US

IV. Provider business mailing address

12308 COUNTRY WHITE CIR
TAMPA FL
33635-6280
US

V. Phone/Fax

Practice location:
  • Phone: 727-267-3879
  • Fax:
Mailing address:
  • Phone: 727-267-3879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11018936
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number9437413
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: