Provider Demographics
NPI:1750864773
Name:BENITEZ, ALICIA E (PA-C)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:E
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12476 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8060
Mailing Address - Country:US
Mailing Address - Phone:954-600-4113
Mailing Address - Fax:
Practice Address - Street 1:68 SCHOOL RD
Practice Address - Street 2:STE 200
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-0000
Practice Address - Country:US
Practice Address - Phone:970-668-2510
Practice Address - Fax:970-668-2511
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA55972363A00000X
COPA.0005563363AM0700X
NC0010-09673363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant