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General NPI Number Information
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NPI Number | 1003180381
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Entity Type | Organization
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Legal Business Name | BENGSTON FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 03/03/2012
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 870 W HICKPOCHEE AVE SSUITE 1700
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City | LABELLE
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State | FL
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Zip | 33935-4313
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Country | US
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Telephone | 863-675-0550
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Fax | 863-675-0553
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Provider Business Mailing Address
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Address Line | 870 W HICKPOCHEE AVE SSUITE 1700
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City | LABELLE
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State | FL
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Zip | 33935-4313
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Country | US
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Telephone | 863-675-0550
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Fax | 863-675-0553
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Authorized Official
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Title or Position | ARNP
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Name | EVELYN SUSANNE BENGSTON
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Credential | ARNP
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Telephone | 863-675-0550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP2209102
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License Number State | FL
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