Provider Demographics
NPI:1689083750
Name:BENNETT, BISONA YEBA (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:DR
First Name:BISONA
Middle Name:YEBA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:DR
Other - First Name:BISONA
Other - Middle Name:YEBA
Other - Last Name:TITALANGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, APRN, FNP-C
Mailing Address - Street 1:305 KINGSLEY LAKE DR STE 703
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3045
Mailing Address - Country:US
Mailing Address - Phone:904-800-4003
Mailing Address - Fax:904-800-5003
Practice Address - Street 1:305 KINGSLEY LAKE DR STE 703
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3045
Practice Address - Country:US
Practice Address - Phone:904-800-4003
Practice Address - Fax:904-800-5003
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11013652363L00000X
TXAP126077363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner