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NPI Code Detail

MEDICARE: DESREEN E BENNETT-BLAKE A.R.N.P.

MEDICARE: DESREEN E BENNETT-BLAKE A.R.N.P.
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
1363L00000XNurse PractitionerARNP2036402FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2ARNP2036402OTHERFLARNP LICENSE

General Provider Information

NPI Number : 1831168558
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESREEN E BENNETT-BLAKE A.R.N.P.
Provider Business Mailing Address
First Line : 7205 S GEORGE BLVD
Second Line :
City : SEBRING
State : FL
Zip : 33875-5847
Country : US
Telephone Number : 863-386-6040
Fax Number : 863-386-6048
Provider Business Practice Location Address
First Line : 7205 S GEORGE BLVD
Second Line :
City : SEBRING
State : FL
Zip : 33875-5847
Country : US
Telephone Number : 863-386-6040
Fax Number : 863-386-6048
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2006
Last Update Date : 12/16/2008

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Directions to “ DESREEN E BENNETT-BLAKE A.R.N.P.” Practice Location

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