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Organization
IDA WALLACE BENNETT FAMILY HEALTH CORPORATION
Active
Organization
IDA WALLACE BENNETT FAMILY HEALTH CORPORATION
Active
Other names
Ida Wallace Bennett Family Corporation
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA V JOHNSON ARNP (PRESIDENT)
(561) 900-6737
Entity
Organization
Contact information
Practice address
331 N DEERFIELD AVE, DEERFIELD BEACH, FL 33441-2028
(561) 900-6737
(954) 422-1726
Mailing address
331 N DEERFIELD AVENUE, DEERFIELD BEACH, FL 33441-2028
(561) 900-6737
(954) 422-1726
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
363L00000X
Nurse Practitioner
Primary
ARNP2155102
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BCBSFL
PTAN AK407
FL
Enumeration date
03/01/2007
Last updated
07/16/2013
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