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General NPI Number Information
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NPI Number | 1912701319
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Entity Type | Organization
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Legal Business Name | LIVIA MEDICAL GROUP
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 2725 PONDS TRAIL
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City | SAINT. CLOUD
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State | FL
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Zip | 34769
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Country | US
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Telephone | 954-914-8474
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Fax | 407-887-1490
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Provider Business Mailing Address
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Address Line | 1711 TROPICAL OASIS AVE
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City | PLANT CITY
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State | FL
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Zip | 33565-5994
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Country | US
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Telephone | 954-914-8474
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Fax | 407-887-1490
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Authorized Official
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Title or Position | OWNER
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Name | JULIA BENNETT
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Credential | ARNP
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Telephone | 850-443-4690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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