Individual
CAROL A BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1302 RIVER ST, PALATKA, FL 32177-5042
(386) 328-8371
(386) 328-1519
Mailing address
1302 RIVER ST, PALATKA, FL 32177-5042
(386) 328-8371
(386) 328-1519
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP1550822
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
308868500
—
FL
01
—
Y0568
BCBS PROVIDER #
FL
Enumeration date
09/20/2006
Last updated
10/31/2013
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