Provider Demographics
NPI:1821894536
Name:BENENATI, GINA MARIE (APRN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:GINA MARIE
Middle Name:
Last Name:BENENATI
Suffix:
Gender:
Credentials:APRN, AGACNP-BC
Other - Prefix:
Other - First Name:GINA MARIE
Other - Middle Name:
Other - Last Name:BENENATI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, AGACNP-BC
Mailing Address - Street 1:14326 SW SOLANGE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-5845
Mailing Address - Country:US
Mailing Address - Phone:631-624-5261
Mailing Address - Fax:
Practice Address - Street 1:1900 NEBRASKA AVE STE 9
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4837
Practice Address - Country:US
Practice Address - Phone:772-465-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11037797363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care