Basic Information
| Provider Information | |||||||||
| NPI: | 1447331327 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | ARNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7313 18TH AVENUE DR W | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342094909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417951744 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6100 POINTE WEST BLVD | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342095533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417921717 | ||||||||
| FaxNumber: | 9417950970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 2831912 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | ARNP 2831912 | 01 | FL | LICENSE | OTHER |