Provider Demographics
NPI:1760664718
Name:BENNETT, AVONNY CADECIA CHRISTEEN (CRNA)
Entity Type:Individual
Prefix:
First Name:AVONNY
Middle Name:CADECIA CHRISTEEN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 W COMMERCIAL BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3392
Mailing Address - Country:US
Mailing Address - Phone:544-855-6669
Mailing Address - Fax:954-585-9207
Practice Address - Street 1:3000 CORAL HILLS DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:954-485-5666
Practice Address - Fax:954-585-9207
Is Sole Proprietor?:No
Enumeration Date:2007-12-02
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9170652367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3091261 00Medicaid
FLG4530OtherBCBS
FL3091261 00Medicaid
FLAK260XMedicare PIN