Provider Demographics
NPI:1093464257
Name:NP BENISE GUTIERREZ
Entity Type:Organization
Organization Name:NP BENISE GUTIERREZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTUS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:813-507-5083
Mailing Address - Street 1:10144 ARBOR RUN DR UNIT 152
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3572
Mailing Address - Country:US
Mailing Address - Phone:813-507-5083
Mailing Address - Fax:888-727-0593
Practice Address - Street 1:10144 ARBOR RUN DR UNIT 152
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3572
Practice Address - Country:US
Practice Address - Phone:813-507-5083
Practice Address - Fax:888-727-0593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG362-061-89-632-0Medicaid