Healthcare Provider Details

I. General information

NPI: 1679376719
Provider Name (Legal Business Name): ASHLIE ANTONIETTE BENJAMIN BS, RN, BSN, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W MAIN ST
APOPKA FL
32712-3451
US

IV. Provider business mailing address

1080 PALOS VERDE DR
ORLANDO FL
32825-8339
US

V. Phone/Fax

Practice location:
  • Phone: 407-595-5054
  • Fax:
Mailing address:
  • Phone: 813-422-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number9620575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: