Provider Demographics
NPI:1497571509
Name:BENAVIDES, JENNY ANGELICA (APRN)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:ANGELICA
Last Name:BENAVIDES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 NE BAYSHORE CT APT 1510
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-6393
Mailing Address - Country:US
Mailing Address - Phone:954-225-1074
Mailing Address - Fax:
Practice Address - Street 1:7950 NE BAYSHORE CT APT 1510
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-6393
Practice Address - Country:US
Practice Address - Phone:954-225-1074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF11240573363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily