Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | ARNP 9219002 | FL |
NPI | 1003084278 |
---|---|
Provider Name | Prof. Henry Henao |
First Address | Miami, FL 33174-2526 |
Second Address | Miami, FL 33199-2924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2008 |
Last Update Date | 05/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AL548Z | (02) | FL |