Provider Demographics
NPI:1104112473
Name:STORIE, BENJAMIN LEE (RN)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:LEE
Last Name:STORIE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12236 ROCHFORD LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-4730
Mailing Address - Country:US
Mailing Address - Phone:904-891-0076
Mailing Address - Fax:904-642-7429
Practice Address - Street 1:12236 ROCHFORD LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-4730
Practice Address - Country:US
Practice Address - Phone:904-891-0076
Practice Address - Fax:904-642-7429
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9226274163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse