MEDICARE: JENNIFER BRYNN BENDOKAS PA-C

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
1	363A00000X	Physician Assistant	PA9114125	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396155206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER BRYNN BENDOKAS PA-C

Provider Business Mailing Address
First Line	:	1005 MAR WALT DR
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6707
Country	:	US
Telephone Number	:	850-863-8275
Fax Number	:	833-916-2240

Provider Business Practice Location Address
First Line	:	1110 HOSPITAL RD
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6742
Country	:	US
Telephone Number	:	850-863-8275
Fax Number	:	833-916-2240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2014
Last Update Date	:	01/05/2023

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