Healthcare Provider Details

I. General information

NPI: 1447352174
Provider Name (Legal Business Name): AMPARO BEATRIZ BENITEZ-BROOME D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 SW 13TH ST
GAINESVILLE FL
32608-4006
US

IV. Provider business mailing address

8860 SW 123RD CT # K410
MIAMI FL
33186-4152
US

V. Phone/Fax

Practice location:
  • Phone: 352-374-5600
  • Fax:
Mailing address:
  • Phone: 305-951-2027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS0007750
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberOS0007750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: