Provider Demographics
NPI:1023199171
Name:BENNETT, JOAN C (ARNP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:C
Last Name:BENNETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7305 N. MILITARY TRAIL
Mailing Address - Street 2:MEDICINE (111)
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6400
Mailing Address - Country:US
Mailing Address - Phone:561-422-6650
Mailing Address - Fax:561-422-8708
Practice Address - Street 1:7305 N. MILITARY TRAIL
Practice Address - Street 2:MEDICINE (111)
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6400
Practice Address - Country:US
Practice Address - Phone:561-422-6650
Practice Address - Fax:561-422-8708
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1876602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVAD000Medicare UPIN