Healthcare Provider Details

I. General information

NPI: 1750587028
Provider Name (Legal Business Name): DR. PATRICK T. HENNESSEY & ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 TURKEY LAKE RD SUITE 208
ORLANDO FL
32819-4200
US

IV. Provider business mailing address

6000 TURKEY LAKE RD SUITE 208
ORLANDO FL
32819-4200
US

V. Phone/Fax

Practice location:
  • Phone: 407-903-0634
  • Fax: 407-206-3676
Mailing address:
  • Phone: 407-903-0634
  • Fax: 407-206-3676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberME63921
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberME63921
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME63921
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME63921
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME63921
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME63921
License Number StateFL

VIII. Authorized Official

Name: DR. PATRICK T HENNESSEY
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 407-903-0634