Provider Demographics
NPI:1457682353
Name:BENNERMAN, MARIBEL
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:BENNERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6403 MONTEREY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-6527
Mailing Address - Country:US
Mailing Address - Phone:813-391-4427
Mailing Address - Fax:501-638-3183
Practice Address - Street 1:6403 MONTEREY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-6527
Practice Address - Country:US
Practice Address - Phone:813-391-4427
Practice Address - Fax:501-638-3183
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-18
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker