Provider Demographics
NPI:1497044853
Name:BENNETT, VICTORIA DENISE (ARNP CNM)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:DENISE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:ARNP CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E BAY DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-2218
Mailing Address - Country:US
Mailing Address - Phone:727-216-1420
Mailing Address - Fax:727-216-1418
Practice Address - Street 1:1900 E BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-2218
Practice Address - Country:US
Practice Address - Phone:727-216-1420
Practice Address - Fax:727-216-1418
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9204058363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology