Provider Demographics
NPI:1275666364
Name:BENNETT, GEORGE JOSEPH (CRNA)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:JOSEPH
Last Name:BENNETT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6126
Mailing Address - Country:US
Mailing Address - Phone:561-204-4513
Mailing Address - Fax:561-204-4513
Practice Address - Street 1:2628 ARBOR LN
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-6126
Practice Address - Country:US
Practice Address - Phone:561-204-4513
Practice Address - Fax:561-204-4513
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL031637282NC2000X
FLARNP1882762367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304297900Medicaid
FLG1091OtherBCBS OF FLORIDA
FL304297900Medicaid