Provider Demographics
NPI:1316960545
Name:BENT, SANDRA H (RN, RRT)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:H
Last Name:BENT
Suffix:
Gender:F
Credentials:RN, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 KETTLE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8129
Mailing Address - Country:US
Mailing Address - Phone:321-297-6029
Mailing Address - Fax:407-343-8565
Practice Address - Street 1:1051 W DONEGAN AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2213
Practice Address - Country:US
Practice Address - Phone:407-343-8344
Practice Address - Fax:407-343-8565
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9227309163W00000X
FLRT18092279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884339200Medicaid