Provider Demographics
NPI:1821813890
Name:BENNETT, DANA LYNN (CSFA)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:LYNN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 GATES POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-1318
Mailing Address - Country:US
Mailing Address - Phone:813-368-4643
Mailing Address - Fax:
Practice Address - Street 1:9330 HWY301 SOUTH
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-1318
Practice Address - Country:US
Practice Address - Phone:656-233-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant