Healthcare Provider Details

I. General information

NPI: 1992969976
Provider Name (Legal Business Name): JOAN R BENZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 STANFORD CT UNIT 701
NAPLES FL
34112-4813
US

IV. Provider business mailing address

2355 STANFORD CT
NAPLES FL
34112-4813
US

V. Phone/Fax

Practice location:
  • Phone: 239-566-7425
  • Fax: 239-593-3430
Mailing address:
  • Phone: 239-566-7425
  • Fax: 239-593-3430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME84720
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLL752
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: