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General NPI Number Information
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NPI Number | 1215229059
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Entity Type | Individual
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Provider Name | AZLEA VANESSA BENNINGTON RN-FNP
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Gender | Female
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 1425 S OSPREY AVE SUITE 5
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City | SARASOTA
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State | FL
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Zip | 34239-2938
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Country | US
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Telephone | 941-554-2149
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 VIRGINIA DR
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City | SARASOTA
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State | FL
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Zip | 34234-7341
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Country | US
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Telephone | 941-806-8872
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 731203
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License Number State | TX
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