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General NPI Number Information
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NPI Number | 1174333868
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Entity Type | Individual
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Provider Name | MARISA BENEDICT PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 640 TYRONE BLVD N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33710-7126
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Country | US
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Telephone | 727-605-5591
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 COUNTRY CLUB RD N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33710-4406
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9119512
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License Number State | FL
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