1760664718 NPI number — AVONNY CADECIA CHRISTEEN BENNETT PMHNP-BC,CRNA

Table of content: AVONNY CADECIA CHRISTEEN BENNETT PMHNP-BC,CRNA (NPI 1760664718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760664718 NPI number — AVONNY CADECIA CHRISTEEN BENNETT PMHNP-BC,CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENNETT
Provider First Name:
AVONNY
Provider Middle Name:
CADECIA CHRISTEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC,CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760664718
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3601 W COMMERCIAL BLVD STE 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33309-3392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
544-855-6669
Provider Business Mailing Address Fax Number:
954-585-9207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 CORAL HILLS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-485-5666
Provider Business Practice Location Address Fax Number:
954-585-9207
Provider Enumeration Date:
12/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  APRN9170652 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: APRN9170652 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G4530 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3091261 00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 309126100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".