Healthcare Provider Details

I. General information

NPI: 1306801253
Provider Name (Legal Business Name): CORRIE L HENRY APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/22/2021
Certification Date: 08/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6859 SW 18TH ST
BOCA RATON FL
33433-7014
US

IV. Provider business mailing address

6859 SW 18TH ST
BOCA RATON FL
33433-7014
US

V. Phone/Fax

Practice location:
  • Phone: 561-368-3775
  • Fax: 561-368-1143
Mailing address:
  • Phone: 561-368-3775
  • Fax: 561-368-1143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number2212
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number000237
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number11005950
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: