Healthcare Provider Details

I. General information

NPI: 1336493519
Provider Name (Legal Business Name): ANNE MARIE BENNETT DNP, APRN, ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 WATERS AVE
SAVANNAH GA
31404-6220
US

IV. Provider business mailing address

12 HENRY CLAY CT
SAVANNAH GA
31411-1519
US

V. Phone/Fax

Practice location:
  • Phone: 912-350-3275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberRN111974
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN111974
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: