Provider Demographics
NPI:1194961979
Name:BENSON, COLLEEN GAIL (APN, C)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:GAIL
Last Name:BENSON
Suffix:
Gender:F
Credentials:APN, C
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:GAIL
Other - Last Name:CONOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN,C
Mailing Address - Street 1:314 EAST MALLORY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483
Mailing Address - Country:US
Mailing Address - Phone:609-731-3079
Mailing Address - Fax:609-731-3079
Practice Address - Street 1:1309 N FLAGLER DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3406
Practice Address - Country:US
Practice Address - Phone:561-655-5511
Practice Address - Fax:954-491-4812
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00178900363LA2200X, 363LF0000X
FLAPRN9472930363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105360900Medicaid