Healthcare Provider Details

I. General information

NPI: 1508091828
Provider Name (Legal Business Name): JENNIFER BENINCASA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2009
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ANDREWS AVENUE
FORT RUCKER AL
36362
US

IV. Provider business mailing address

301 ANDREWS AVE
FORT RUCKER AL
36362
US

V. Phone/Fax

Practice location:
  • Phone: 800-261-7193
  • Fax:
Mailing address:
  • Phone: 334-255-7409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberDOS1358
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: