Healthcare Provider Details

I. General information

NPI: 1003084278
Provider Name (Legal Business Name): HENRY HENAO MSN, ARNP, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 07/05/2020
Certification Date: 07/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 SW 8TH STREET ACADEMIC HEALTH CENTER 3, 305A
MIAMI FL
33199-2924
US

IV. Provider business mailing address

1421 SW 107TH AVE STE 118
MIAMI FL
33174-2526
US

V. Phone/Fax

Practice location:
  • Phone: 305-348-1082
  • Fax:
Mailing address:
  • Phone: 305-490-0494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberEMT 304782
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9219002
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: