Provider Demographics
NPI:1265859516
Name:BENSON, SAM N (APRN)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:N
Last Name:BENSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33836-0878
Mailing Address - Country:US
Mailing Address - Phone:689-698-3720
Mailing Address - Fax:689-369-8537
Practice Address - Street 1:2925 AVENTURA BLVD STE 302
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3109
Practice Address - Country:US
Practice Address - Phone:305-931-9002
Practice Address - Fax:305-692-9176
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN9342307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012148400Medicaid