Provider Demographics
NPI:1215761069
Name:BENAVIDES, CHRISTINA C (FNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:C
Last Name:BENAVIDES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 SW 147TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3702
Mailing Address - Country:US
Mailing Address - Phone:954-999-2278
Mailing Address - Fax:
Practice Address - Street 1:18503 PINES BLVD STE 309
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1406
Practice Address - Country:US
Practice Address - Phone:954-999-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL674862363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner