Provider Demographics
NPI:1851017321
Name:BENNETT, CHEZ NICOLE
Entity Type:Individual
Prefix:MRS
First Name:CHEZ
Middle Name:NICOLE
Last Name:BENNETT
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 1:2311 ALT 19
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2631
Mailing Address - Country:US
Mailing Address - Phone:727-386-6061
Mailing Address - Fax:
Practice Address - Street 1:2311 ALT 19
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-2631
Practice Address - Country:US
Practice Address - Phone:727-386-6061
Practice Address - Fax:727-787-0134
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator