10D2059642 CLIA NUMBER - DEMETRA BENNETT ARNP LLC

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Laboratory Demographics

CLIA Number: 10D2059642

Facility Name: DEMETRA BENNETT ARNP LLC

Facility Address:
930 MARCUM RD STE 5
LAKELAND, FL
ZIP 33809
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Facility Phone Number: 863 940-4886

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1184676025

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	10D2059642
LAB Type	Practitioner Other
Facility Name	DEMETRA BENNETT ARNP LLC
Street	930 MARCUM RD STE 5
City	LAKELAND
State	FL
ZIP	33809
Phone	863 940-4886
CertificateType	4
CertificateEffectiveDate	5/28/2023
CertificateExpirationDate	5/27/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024