Provider Demographics
NPI:1215272968
Name:BENJAMIN, CARLA (FNP)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10770 N 46TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-3442
Mailing Address - Country:US
Mailing Address - Phone:813-903-3611
Mailing Address - Fax:813-631-3181
Practice Address - Street 1:10770 N 46TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-3442
Practice Address - Country:US
Practice Address - Phone:813-903-3611
Practice Address - Fax:813-631-3181
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3073902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL230601800Medicaid