Provider Demographics
NPI:1215229059
Name:BENNINGTON, AZLEA VANESSA (RN-FNP)
Entity type:Individual
Prefix:MISS
First Name:AZLEA
Middle Name:VANESSA
Last Name:BENNINGTON
Suffix:
Gender:F
Credentials:RN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-7341
Mailing Address - Country:US
Mailing Address - Phone:941-806-8872
Mailing Address - Fax:
Practice Address - Street 1:1425 S OSPREY AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2938
Practice Address - Country:US
Practice Address - Phone:941-554-2149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX731203363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner