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NPI Code Detail

MEDICARE: STEPHANIE ANN BENTON

MEDICARE: STEPHANIE ANN BENTON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1343900000XNon-emergency Medical Transport (VAN)H214979104000FL

General Provider Information

NPI Number : 1114781481
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE ANN BENTON
Provider Business Mailing Address
First Line : 1157 E GROVE AVE
Second Line :
City : LAKE WALES
State : FL
Zip : 33853-4985
Country : US
Telephone Number : 863-651-0109
Fax Number :
Provider Business Practice Location Address
First Line : 1157 E GROVE AVE
Second Line :
City : LAKE WALES
State : FL
Zip : 33853-4985
Country : US
Telephone Number : 863-651-0109
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2024
Last Update Date : 03/03/2026

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