| Organization Name: | BENGSTON FAMILY PRACTICE LLC |
| NPI Number: | 1003180381 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EVELYN SUSANNE BENGSTON (ARNP) |
| Mailing Address: | 870 W Hickpochee Ave Ssuite 1700 Labelle |
| State: | FL US |
| Postal Code: | 339354313 |
| Phone Number: | 8636750550 |
| Fax Number: | 8636750553 |
| NPI Enumeration Date: | 03/03/2012 |
| NPI Last Update Date: | 03/07/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | ARNP2209102 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |