Provider Demographics
NPI:1386915015
Name:BENEDICT, TATJANA (PA-C)
Entity type:Individual
Prefix:
First Name:TATJANA
Middle Name:
Last Name:BENEDICT
Suffix:
Gender:
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 1:1012 TAYWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-5795
Mailing Address - Country:US
Mailing Address - Phone:919-602-6746
Mailing Address - Fax:
Practice Address - Street 1:160 MACGREGOR PINES DR STE 301
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6037
Practice Address - Country:US
Practice Address - Phone:919-890-9059
Practice Address - Fax:919-890-9069
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03158363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant