Individual
JENNIFER L BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
509 S ARMENIA AVE STE 200, TAMPA, FL 33609-3395
(813) 974-2201
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME69510
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272137600
—
FL
01
—
46820
BLUE CROSS BLUE SHIELD
FL
Enumeration date
11/08/2005
Last updated
03/30/2021
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