Organization Active NPI

Demetra Bennett Arnp LLC

  • Primary Care Clinic/Center
  • Lakeland, FL
National Provider Identifier
1992022313
Registry record updated Apr 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
9164847 Issued in FL
Legal business name
DEMETRA BENNETT ARNP LLC
Practice address
3628 Harden Blvd
Lakeland, FL 33803-5938
Phone
(863) 701-2225
NPI assigned
Apr 25, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Demetra Bennett, ARNPNPI 1184676025
Title
Owner
Phone
(352) 585-0768

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 9164847 FL Primary

Addresses

Primary practice location

3628 Harden Blvd
Lakeland, FL 33803-5938

Mailing address

3628 Harden Blvd
Lakeland, FL 33803-5938
Phone (863) 701-2225

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101004000554 FL Part B Supplier - Clinic/Group Practice 2769674241 Receives reassigned benefits from 1 practitioner
Practice locations: Lakeland, FL

National Provider Directory

National Provider Directory

Locations

3628 Harden Blvd
Lakeland, FL 33803
Phone (863) 701-2225

2390 Griffin Rd
Lakeland, FL 33810
Phone (863) 859-0335

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1272153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272153600000",
    "number": "1992022313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3628 HARDEN BLVD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338035938",
            "telephone_number": "863-701-2225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3628 HARDEN BLVD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338035938",
            "telephone_number": "863-701-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEMETRA BENNETT ARNP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-25",
        "last_updated": "2010-04-25",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "DEMETRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-585-0768",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "9164847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.