MEDICARE: LUISA VILLATORO BENITEZ DNP, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024190822	VA

General Provider Information

NPI Number	:	1205666476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUISA VILLATORO BENITEZ DNP, FNP-BC

Provider Business Mailing Address
First Line	:	7617 LITTLE RIVER TPKE STE 850
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-2673
Country	:	US
Telephone Number	:	571-268-9632
Fax Number	:

Provider Business Practice Location Address
First Line	:	7617 LITTLE RIVER TPKE STE 850
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-2673
Country	:	US
Telephone Number	:	571-665-6636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2024
Last Update Date	:	08/08/2024

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