Bennett, Roosevelt

Bennett, Roosevelt is an individual health care provider with primary practice located at 807 Childrens Way Nemours Childrens Specialty Care, Jacksonville, Jacksonville FL 32207-8426. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant, which is considered as his primary health care specialty. Bennett, Roosevelt can be contacted via phone (904) 697-3600.

Contact Information

Primary practice address
807 Childrens Way Nemours Childrens Specialty Care, Jacksonville Jacksonville FL 32207-8426
Phone: (904) 697-3600
Fax: (904) 697-3927
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant 367H00000X AA100 Florida

Profile Details

NPI number 1184900177
LBN Legal business name Bennett, Roosevelt
Credentials AA-C
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 23rd, 2011
Last updated Jan 9th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184900177 NPPES
Florida MEDICAID 004228800

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