Provider Demographics
NPI:1598957607
Name:BENSON, ANGELLA M (ARNP)
Entity Type:Individual
Prefix:
First Name:ANGELLA
Middle Name:M
Last Name:BENSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:990 TAMIAMI TRL N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5403
Practice Address - Country:US
Practice Address - Phone:239-434-6300
Practice Address - Fax:239-434-7174
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9187539363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308620800Medicaid
FLY0J2BOtherBCBS OF FL
FLP01213804OtherRAILROAD MCR
FLAK135WMedicare PIN
FLP01213804OtherRAILROAD MCR