Provider Demographics
NPI:1679922140
Name:BENITEZ, SHERRY LEE (FNP-C)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LEE
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SHERRIE
Other - Middle Name:LEE
Other - Last Name:HOLLARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:11661 PRESTON RD STE 218
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11661 PRESTON RD STE 218
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6173
Practice Address - Country:US
Practice Address - Phone:214-363-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130439363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX530955YKP5Medicare PIN
TX530955YKQLMedicare PIN