Provider Demographics
NPI:1225841893
Name:BENNETT, NICHOLAS FERNANDEZ
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:FERNANDEZ
Last Name:BENNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3828
Mailing Address - Country:US
Mailing Address - Phone:727-405-9426
Mailing Address - Fax:
Practice Address - Street 1:6150 ENTERPRISE PKWY
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2755
Practice Address - Country:US
Practice Address - Phone:407-640-2146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator