Provider Demographics
NPI:1710644943
Name:BENITEZ, CHARISSE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:CHARISSE
Middle Name:
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 GUERRA DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8888
Mailing Address - Country:US
Mailing Address - Phone:956-206-6114
Mailing Address - Fax:
Practice Address - Street 1:3115 GUERRA DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-8888
Practice Address - Country:US
Practice Address - Phone:956-206-6114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily