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General NPI Number Information
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NPI Number | 1821813890
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Entity Type | Individual
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Provider Name | DANA LYNN BENNETT CSFA
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Gender | Female
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 9330 HWY301 SOUTH
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City | RIVERVIEW
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State | FL
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Zip | 33578-1318
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Country | US
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Telephone | 656-233-5628
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Fax |
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Provider Business Mailing Address
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Address Line | 6601 GATES POINTE WAY
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City | RIVERVIEW
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State | FL
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Zip | 33578-1318
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Country | US
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Telephone | 813-368-4643
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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