Provider Demographics
NPI:1083087365
Name:BENOIT, ANTHONY (RN)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BENOIT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 W STASSNEY LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-2947
Mailing Address - Country:US
Mailing Address - Phone:512-440-4800
Mailing Address - Fax:512-440-4835
Practice Address - Street 1:1407 W STASSNEY LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-2947
Practice Address - Country:US
Practice Address - Phone:512-440-4800
Practice Address - Fax:512-440-4835
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX725787163W00000X
TXAP134702363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse