Provider Demographics
NPI:1083222558
Name:BENITEZ, HECTOR MANUEL (FNP)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:MANUEL
Last Name:BENITEZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 NORTHVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-9064
Mailing Address - Country:US
Mailing Address - Phone:615-804-7902
Mailing Address - Fax:
Practice Address - Street 1:133 INDIAN LAKE RD STE 204
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3883
Practice Address - Country:US
Practice Address - Phone:615-338-6341
Practice Address - Fax:615-338-6342
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27202261QM1300X, 363LP0808X
VA0024184676363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty