Provider Demographics
NPI:1053421776
Name:PEREIRA, BENVINDA ANN (FNP)
Entity type:Individual
Prefix:
First Name:BENVINDA
Middle Name:ANN
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 E BELL RD STE 2200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2139
Mailing Address - Country:US
Mailing Address - Phone:602-633-3838
Mailing Address - Fax:602-633-3845
Practice Address - Street 1:255 N. CENTRAL BLVD.
Practice Address - Street 2:SUITE #5
Practice Address - City:QUARTZSITE
Practice Address - State:AZ
Practice Address - Zip Code:85346
Practice Address - Country:US
Practice Address - Phone:928-927-6105
Practice Address - Fax:928-927-6110
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN115611363LF0000X
AZAP1431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ641474Medicaid
AZZ164332OtherMEDICARE
AZCG7880OtherMEDICARE RAILROAD GROUP
AZAZ0147610OtherBCBS
AZP00235241OtherMEDICARE RAILROAD
AZ641474Medicaid