Provider Demographics
NPI:1316432503
Name:BENNETT, HEATHER PAULINE (ARPN-C)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:PAULINE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:ARPN-C
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Mailing Address - Street 1:705 WELLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2982
Mailing Address - Country:US
Mailing Address - Phone:904-282-6331
Mailing Address - Fax:904-619-1080
Practice Address - Street 1:3839 COUNTY ROAD 218
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068
Practice Address - Country:US
Practice Address - Phone:904-282-5474
Practice Address - Fax:904-282-5824
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2021-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9249743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100189500Medicaid