| 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 |
|---|---|
| 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 |
|---|---|---|---|
| 1134226699 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | OS 8054 (Florida) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| 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 |