Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | DN 16425 | FL |
N | 213EG0000X | General Practice | DN 16425 | FL |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN16425 | FL |
Y | 204E00000X | Oral & Maxillofacial Surgeon | DN 16425 | FL |
N | 204E00000X | Oral & Maxillofacial Surgeon | ME113042 | FL |
N | 208200000X | Surgeon | ME113042 | FL |
N | 208600000X | Surgeon | ME113042 | FL |
NPI | 1093821647 |
---|---|
Provider Name | Dr. Stephanie Reeder Henley |
First Address | Jacksonville Beach, FL 32250-1800 |
Second Address | Jacksonville, FL 32216-8710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 04/02/2019 |