Healthcare Provider Details

I. General information

NPI: 1114832375
Provider Name (Legal Business Name): SCOTT ERIC BENNETT R.R.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N LAKEMONT AVE
WINTER PARK FL
32792-3273
US

IV. Provider business mailing address

3975 SHERMAN HILLS PKWY W
JACKSONVILLE FL
32210-0436
US

V. Phone/Fax

Practice location:
  • Phone: 407-599-6030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License NumberRA27
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: