Provider Demographics
NPI:1235518481
Name:BENNETT, ARIELLE (APRN)
Entity Type:Individual
Prefix:
First Name:ARIELLE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2221
Mailing Address - Country:US
Mailing Address - Phone:941-388-0940
Mailing Address - Fax:941-388-0921
Practice Address - Street 1:1961 FLOYD ST STE C
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2931
Practice Address - Country:US
Practice Address - Phone:941-388-0940
Practice Address - Fax:941-388-0921
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1235518481363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11014652OtherAPRN
FL11014652OtherFBON