Healthcare Provider Details

I. General information

NPI: 1518924893
Provider Name (Legal Business Name): JOSEPH HENSON P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 MORTON PLANT ST STE 301
CLEARWATER FL
33756-3395
US

IV. Provider business mailing address

430 MORTON PLANT ST STE 301
CLEARWATER FL
33756-3395
US

V. Phone/Fax

Practice location:
  • Phone: 727-461-6026
  • Fax: 727-461-1492
Mailing address:
  • Phone: 727-461-6026
  • Fax: 727-461-1492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA3589
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA3589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: