Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 11003318 | FL |
N | 363LC1500X | Nurse Practitioner - Community Health | 11003318 | FL |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 11003318 | FL |
N | 363LP2300X | Nurse Practitioner - Primary Care | 11003318 | FL |
NPI | 1457905622 |
---|---|
Provider Name | Marisol Bennett |
First Address | Cutler Bay, FL 33190-1332 |
Second Address | Cutler Bay, FL 33190-1332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2019 |
Last Update Date | 14/08/2019 |