Provider Demographics
NPI:1770956971
Name:EDMEADE, BENNITTA DENISE (APRN)
Entity type:Individual
Prefix:
First Name:BENNITTA
Middle Name:DENISE
Last Name:EDMEADE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8051 N TAMIAMI TRL STE E6
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2067
Mailing Address - Country:US
Mailing Address - Phone:407-501-8886
Mailing Address - Fax:
Practice Address - Street 1:8051 N TAMIAMI TRL STE E6
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2067
Practice Address - Country:US
Practice Address - Phone:407-501-8886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9283268363LF0000X, 363LP2300X
FLAPRN9283268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care