Provider Demographics
NPI:1740267913
Name:BENFIELD, LISA D (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:BENFIELD
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3224 N ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4114
Mailing Address - Country:US
Mailing Address - Phone:305-294-8441
Mailing Address - Fax:305-296-3383
Practice Address - Street 1:3224 N ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4114
Practice Address - Country:US
Practice Address - Phone:305-294-8441
Practice Address - Fax:305-296-3383
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9256849363LF0000X
MSR631418363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119221Medicaid
MSS50485Medicare UPIN
MS500000298Medicare ID - Type UnspecifiedNURSE PRACTITIONER