Healthcare Provider Details

I. General information

NPI: 1114650165
Provider Name (Legal Business Name): REBECCA HENNING PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7035 BAYFRONT SCENIC DR UNIT 5214
ORLANDO FL
32819-2222
US

IV. Provider business mailing address

7035 BAYFRONT SCENIC DR UNIT 5214
ORLANDO FL
32819-2222
US

V. Phone/Fax

Practice location:
  • Phone: 716-946-5901
  • Fax:
Mailing address:
  • Phone: 716-946-5901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number69042301
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404561
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: