Provider Demographics
NPI:1366030918
Name:BENCHEKROUN, FATIMA EZZAHRAE
Entity Type:Individual
Prefix:
First Name:FATIMA EZZAHRAE
Middle Name:
Last Name:BENCHEKROUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 WEBB RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2859
Mailing Address - Country:US
Mailing Address - Phone:813-496-9663
Mailing Address - Fax:813-496-9921
Practice Address - Street 1:6101 WEBB RD STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2859
Practice Address - Country:US
Practice Address - Phone:813-496-9663
Practice Address - Fax:813-496-9921
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112948363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant