Healthcare Provider Details

I. General information

NPI: 1376285411
Provider Name (Legal Business Name): MICHELLE SONG HENRY DNP-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2022
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 S PINE AVE
OCALA FL
34471-5150
US

IV. Provider business mailing address

2300 S PINE AVE
OCALA FL
34471-5150
US

V. Phone/Fax

Practice location:
  • Phone: 352-861-4600
  • Fax:
Mailing address:
  • Phone: 352-861-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR199523
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11024024
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: