Individual
MS. DONNA MARIE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, PHARMD
Contact information
Practice address
13340 METRO PKWY STE 400, FORT MYERS, FL 33966-4818
(239) 343-1105
(239) 343-1106
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-1105
(239) 343-1106
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
5302029356
MI
363A00000X
Physician Assistant
5601003193
MI
363AM0700X
Medical Physician Assistant
Primary
PA 9106085
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004777100
—
FL
Enumeration date
01/20/2007
Last updated
03/24/2021
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