Healthcare Provider Details

I. General information

NPI: 1295507473
Provider Name (Legal Business Name): CYNTHIA LYNN BENNETT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 LORTON STATION BLVD STE 270
LORTON VA
22079-4798
US

IV. Provider business mailing address

9010 LORTON STATION BLVD STE 270
LORTON VA
22079-4798
US

V. Phone/Fax

Practice location:
  • Phone: 540-898-6500
  • Fax: 540-834-0363
Mailing address:
  • Phone: 540-898-6500
  • Fax: 540-834-0363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024188468
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: