Dr Tara Lorence Vanbennekom, DO | |
304 Kingsley Lake Drive, Suite #603, St. Augustine, FL 32092 | |
(904) 824-5437 | |
Not Available |
Full Name | Dr Tara Lorence Vanbennekom |
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Gender | Female |
Speciality | Pediatrics |
Location | 304 Kingsley Lake Drive, St. Augustine, Florida |
Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
Identifier | Type | State | Issuer |
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1134226699 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | OS 8054 (Florida) | Primary |
Mailing Address | Practice Location Address |
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Dr Tara Lorence Vanbennekom, DO 201 St. Johns Forest Blvd, Jacksonville, FL 32259 Ph: (904) 824-5796 | Dr Tara Lorence Vanbennekom, DO 304 Kingsley Lake Drive, Suite #603, St. Augustine, FL 32092 Ph: (904) 824-5437 |