Provider Demographics
NPI:1609830322
Name:BENNETT, CHRISTINE J (ARNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:J
Last Name:BENNETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 7TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1310
Mailing Address - Country:US
Mailing Address - Phone:727-894-4738
Mailing Address - Fax:727-823-6710
Practice Address - Street 1:1201 7TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1310
Practice Address - Country:US
Practice Address - Phone:727-894-4738
Practice Address - Fax:727-823-6710
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP793982163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP793982Medicare ID - Type Unspecified
FLP72607Medicare UPIN