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Individual

BRIA LEIGH BENNIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
102 PARK PLACE BLVD STE 3, KISSIMMEE, FL 34741-2358
(407) 944-4900
(407) 483-0688
Mailing address
102 PARK PLACE BLVD. BLDG. D, SUITE 3, KISSIMMEE, FL 34741-2358
(407) 944-4900
(407) 483-0688

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9105229
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
45-5436649
FL
Enumeration date
10/08/2009
Last updated
11/07/2017
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