Provider Demographics
NPI:1902156524
Name:BENFIELD, ERIKA BROSLAT (FNP-C)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:BROSLAT
Last Name:BENFIELD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:DAWN
Other - Last Name:BROSLAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 W WINDCREST ST
Mailing Address - Street 2:CORNERSTONE CLINIC
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4481
Mailing Address - Country:US
Mailing Address - Phone:830-997-0330
Mailing Address - Fax:830-997-7601
Practice Address - Street 1:200 W WINDCREST ST
Practice Address - Street 2:CORNERSTONE CLINIC
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4481
Practice Address - Country:US
Practice Address - Phone:830-997-0330
Practice Address - Fax:830-997-7601
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX779618363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX885N62OtherBCBSTX
TX310837501Medicaid
P01108626OtherMEDICARE RAILROAD
TXTXB164315Medicare PIN