DEMETRA BENNETT (NPI# 1184676025) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184676025 |
| Entity Type | Individual |
| Full Name | DEMETRA BENNETT |
| Credential | NP |
| Practice Address |
930 Marcum Rd Ste 5 Lakeland FL 33809-4308 |
| Mailing Address |
3376 Fiddle Leaf Way Lakeland FL 33811-3001 |
| Practice Telephone | 8639404886 |
| Practice Fax Number | 8638165769 |
| Mailing Telephone | 8636028174 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2020-09-09 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | ARNP9164847 | FL | Allopathic & Osteopathic Physicians |
| N | 363L00000X | Nurse Practitioner | 9164847 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
APRN9164847 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 306599500 | 05 |
| Street Address |
930 MARCUM RD STE 5 |
| City | LAKELAND |
| State | FL |
| Zip Code | 33809-4308 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861018178 | John C Gallik | Military Health Care Provider | 3176 Corporal Johnson Road, Jbsa Fort Sam Houston, TX 33809 | 2020-06-23 |
| 1376189209 | Julie Independence Tomchak | Nurse's Aide | 7805 Us Highway Lot 29 # 98 N, Lakeland, FL 33809 | 2019-11-26 |
| 1912465923 | Lakeland Oaks Nh LLC | Skilled Nursing Facility | 855 Carpenters Way, Lakeland, FL 33809 | 2019-03-08 |
| 1235528753 | Christia Mccann | Physician Assistant | 4120 Us Hwy. 98 N., One Lakeland Square, Lakeland, FL 33809 | 2015-01-21 |
| 1548679616 | Ashley Frances Hamarowicz | Physical Therapist | 771 Carpenters Way, Lakeland, FL 33809 | 2014-08-04 |
| 1750700860 | Grace Manor Suites | Assisted Living Facility | 4620 N Socrum Loop Road, Lakeland, FL 33809 | 2014-04-16 |
| 1164769980 | Christopher Fisher | Hearing Instrument Specialist | 3800 North Rd 98, Ste 500, Lakeland, FL 33809 | 2013-01-14 |
| 1023374063 | Eagle Lake Pharmacy Inc | Pharmacy | 5245 A U S Hwy 98 N, Suite A, Lakeland, FL 33809 | 2012-04-04 |
| 1851669675 | Reginald Keith Jenkins | Pharmacist | 1043 Walt Williams Road, Lakeland, FL 33809 | 2011-12-07 |
| 1578859633 | Jill Margaret Waldrop | Pharmacist | 6600 N. Socrum Loop, Lakeland, FL 33809 | 2011-06-27 |
| Find all providers in zip 33809 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851906994 | Janine Marie Divincenzo-smith | Nurse Practitioner | 2927 Northbrook Ln, Lakeland, FL 33811-1663 | 2020-09-15 |
| 1225643638 | Erin Garza | Nurse Practitioner | 1606 Lakewood Dr N, Lakeland, FL 33813-3241 | 2020-09-11 |
| 1184240228 | Alexis Michele Ramos | Nurse Practitioner | 858 Rockingham Rd, Lakeland, FL 33809-4044 | 2020-06-24 |
| 1326664632 | Lindsey R Cromer | Nurse Practitioner | 6945 Ashbury Dr, Lakeland, FL 33809-7804 | 2020-06-23 |
| 1043846611 | Amy Melissa Eaton | Nurse Practitioner | 1123 Walt Williams Rd Lot 192, Lakeland, FL 33809-2392 | 2020-03-16 |
| 1265066732 | Komal Meghat | Nurse Practitioner | 707 Arbor Glen Cir Apt 103, Lakeland, FL 33805-2376 | 2020-02-24 |
| 1629609391 | Brooke Nicole Brooks | Nurse Practitioner | 6883 Lake Eaglebrooke Dr, Lakeland, FL 33813-5667 | 2020-01-30 |
| 1568001774 | Theava Ismarella Preston | Nurse Practitioner | 1409 Alameda Dr S, Lakeland, FL 33805-2301 | 2020-01-06 |
| 1497394738 | Denise Thaxter | Nurse Practitioner | 3262 Pebblebrooke Blvd, Lakeland, FL 33810-1305 | 2020-01-03 |
| 1205478724 | Jisha Mathew | Nurse Practitioner | 2636 High Ridge Dr, Lakeland, FL 33812-5883 | 2019-10-16 |
| Find all providers in LAKELAND | ||||
Please comment or provide details below to improve the information on DEMETRA BENNETT.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.