Healthcare Provider Details

I. General information

NPI: 1346918786
Provider Name (Legal Business Name): MICHAEL LEWIS HENRY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 PRUDENTIAL DR FL 10
JACKSONVILLE FL
32207-8329
US

IV. Provider business mailing address

PO BOX 746649
ATLANTA GA
30374-6649
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-5404
  • Fax: 904-391-5545
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-376-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11026468
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number30077
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11026468
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: