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General NPI Number Information
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NPI Number | 1689083750
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Entity Type | Individual
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Provider Name | BISONA YEBA BENNETT DNP, APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 305 KINGSLEY LAKE DR STE 703
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-3045
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Country | US
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Telephone | 904-800-4003
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Fax | 904-800-5003
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Provider Business Mailing Address
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Address Line | 305 KINGSLEY LAKE DR STE 703
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-3045
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Country | US
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Telephone | 904-800-4003
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Fax | 904-800-5003
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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 | 11013652
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License Number State | FL
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