Provider Demographics
NPI:1093765489
Name:BENJAMIN, SUZANNE F (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:F
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 N 12TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-6023
Mailing Address - Country:US
Mailing Address - Phone:602-265-4357
Mailing Address - Fax:602-604-9352
Practice Address - Street 1:4222 N 12TH ST STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-6023
Practice Address - Country:US
Practice Address - Phone:602-265-4357
Practice Address - Fax:602-604-9352
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN035803363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ453324Medicaid
AZ453324Medicaid