Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APRN2875992 | FL |
NPI | 1003066713 |
---|---|
Provider Name | Charmaine Henry |
First Address | Tampa, FL 33613-1220 |
Second Address | Tampa, FL 33613-1220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2008 |
Last Update Date | 15/01/2019 |