Healthcare Provider Details

I. General information

NPI: 1114752714
Provider Name (Legal Business Name): CORY HENSLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38240 DAUGHTERY RD
ZEPHYRHILLS FL
33540-1367
US

IV. Provider business mailing address

14122 JENNIFER WAY
DADE CITY FL
33525-7778
US

V. Phone/Fax

Practice location:
  • Phone: 813-788-3582
  • Fax: 813-780-6707
Mailing address:
  • Phone: 813-447-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11033771
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: