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NPI Code Detail

MEDICARE: EVELYN SUSANNE BENGSTON APRN

MEDICARE: EVELYN SUSANNE BENGSTON 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
1363LF0000XFamily Nurse PractitionerARNP2209102FL

Other Identifiers

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

General Provider Information

NPI Number : 1881685758
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVELYN SUSANNE BENGSTON APRN
Provider Business Mailing Address
First Line : 18743 NW 234TH ST
Second Line :
City : HIGH SPRINGS
State : FL
Zip : 32643-0465
Country : US
Telephone Number : 386-454-0721
Fax Number : 386-454-0722
Provider Business Practice Location Address
First Line : 18743 NW 234TH ST
Second Line :
City : HIGH SPRINGS
State : FL
Zip : 32643-0465
Country : US
Telephone Number : 386-454-0721
Fax Number : 386-454-0722
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2005
Last Update Date : 02/05/2025

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