Healthcare Provider Details

I. General information

NPI: 1700416377
Provider Name (Legal Business Name): LEIDY MARCELA HENAO ARNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7603 DAVIE ROAD EXT
HOLLYWOOD FL
33024-2623
US

IV. Provider business mailing address

7603 DAVIE ROAD EXT
HOLLYWOOD FL
33024-2623
US

V. Phone/Fax

Practice location:
  • Phone: 305-988-9010
  • Fax: 954-932-5087
Mailing address:
  • Phone: 305-988-9010
  • Fax: 954-932-5087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11005801
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11005801
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: