Provider Demographics
NPI:1992589774
Name:BENTON, ERICA LYNN (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:BENTON
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LYNN
Other - Last Name:TREMBLAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33C EDGERTON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02556-2844
Mailing Address - Country:US
Mailing Address - Phone:508-633-8485
Mailing Address - Fax:
Practice Address - Street 1:33C EDGERTON DR
Practice Address - Street 2:
Practice Address - City:NORTH FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02556-2844
Practice Address - Country:US
Practice Address - Phone:774-552-3211
Practice Address - Fax:508-771-9555
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2311846363LA2100X, 363LG0600X, 363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care