JESSICA BENNETT, ARNP — NPI 1104466556 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Women’s Health in FORT WALTON BEACH, FL)

CMS-1500 Box 24J / 33a • NPI

1104466556

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363LW0102X (CMS 50)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Women’s Health

Box 32 Service Location & ZIP+4

221 HOSPITAL DR NE, FORT WALTON BEACH, FL, 32548-5066

✓ 9-Digit EDI 837 ZIP+4 (32548-5066)

Practice Phone & Referral Fax

(850) 833-9240

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1104466556 (JESSICA BENNETT, ARNP) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1104466556` (NPI-1 Individual Practitioner)
Provider / Legal Name	JESSICA BENNETT, ARNP
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Women’s Health NUCC Code: `363LW0102X` (Nurse Practitioner, Women's Health)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	221 HOSPITAL DR NE, FORT WALTON BEACH, FL, 32548-5066
Practice Telephone / Fax	Tel: (850) 833-9240
Administrative Mailing Address	178 KEL WEN CIR, DESTIN, FL, 32541-3711
Enumeration & Last Sync	Enumerated: 2020-01-14 \| CMS Record Updated: 2020-01-14

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

221 HOSPITAL DR NE, FORT WALTON BEACH, FL, 32548-5066

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Plain-English Taxonomy & CMS Crosswalk (363LW0102X)

What Does Taxonomy Code 363LW0102X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LW0102X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Women’s Health"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 50 (Nurse Practitioner)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nurse Practitioner, Women's Health for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (JESSICA BENNETT, ARNP)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`363LW0102X` — Nurse Practitioner, Women's Health Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Women’s Health	State: FL \| License: `11002546` \| Primary: Yes (Primary)

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JESSICA BENNETT, ARNP (NPI #1104466556)