Healthcare Provider Details

I. General information

NPI: 1053291989
Provider Name (Legal Business Name): MARIA HENRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 E 28TH AVE
TAMPA FL
33605-1525
US

IV. Provider business mailing address

3408 E 28TH AVE
TAMPA FL
33605-1525
US

V. Phone/Fax

Practice location:
  • Phone: 813-564-7030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11041287
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: