Individual
MRS. TARA ALEA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
500 LAKESHORE PKWY, ROCK HILL, SC 29730-4273
(803) 818-6955
(803) 818-6993
Mailing address
500 LAKESHORE PKWY, ROCK HILL, SC 29730-4273
(803) 818-6955
(803) 818-6993
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
18300
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP2628
—
SC
Enumeration date
08/07/2013
Last updated
08/23/2021
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