Provider Demographics
NPI:1932520616
Name:BENNETT, JOHNICA M (DNP, CNM, ARNP)
Entity Type:Individual
Prefix:
First Name:JOHNICA
Middle Name:M
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DNP, CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-3426
Mailing Address - Country:US
Mailing Address - Phone:561-996-9573
Mailing Address - Fax:561-996-9620
Practice Address - Street 1:232 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-3426
Practice Address - Country:US
Practice Address - Phone:561-996-9573
Practice Address - Fax:561-996-9620
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3168772367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife