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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