Healthcare Provider Details

I. General information

NPI: 1518587609
Provider Name (Legal Business Name): CARLOS ENRIQUE CONTRERAS BENITEZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 10/03/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 S CHARLES RICHARD BEALL BLVD
DEBARY FL
32713-3332
US

IV. Provider business mailing address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 386-516-0930
  • Fax: 386-668-6897
Mailing address:
  • Phone: 210-630-2207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11034874
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberNJDCATEMP-007787
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: