Provider Demographics
NPI:1598139834
Name:BENNETT, DONNA JOANNE (RN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JOANNE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 HUMMINGBIRD RD
Mailing Address - Street 2:
Mailing Address - City:BASCOM
Mailing Address - State:FL
Mailing Address - Zip Code:32423-9136
Mailing Address - Country:US
Mailing Address - Phone:850-569-2627
Mailing Address - Fax:
Practice Address - Street 1:5580 HUMMINGBIRD RD
Practice Address - Street 2:
Practice Address - City:BASCOM
Practice Address - State:FL
Practice Address - Zip Code:32423-9136
Practice Address - Country:US
Practice Address - Phone:850-569-2627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9388168163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse