MEDICARE: MARLENE BENNETT APRN

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	363LC0200X	Critical Care Medicine Nurse Practitioner	APRN11039010	FL
2	363LF0000X	Family Nurse Practitioner	APRN11039010	FL

General Provider Information

NPI Number	:	1467336016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLENE BENNETT APRN

Provider Business Mailing Address
First Line	:	140 PINNACLES DR
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-2322
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 PINNACLES DR
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-2322
Country	:	US
Telephone Number	:	386-597-2829
Fax Number	:

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

Provider Enumeration Date	:	08/05/2025
Last Update Date	:	08/05/2025

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