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General NPI Number Information
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NPI Number | 1215962709
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Entity Type | Individual
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Provider Name | TIMOTHY JAMES HENNE D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 3150 CITRUS TOWER BLVD SUITE B
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City | CLERMONT
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State | FL
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Zip | 34711-6802
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Country | US
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Telephone | 352-242-2502
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Fax | 352-242-0316
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Provider Business Mailing Address
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Address Line | 3190 CITRUS TOWER BLVD STE A
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City | CLERMONT
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State | FL
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Zip | 34711-6886
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Country | US
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Telephone | 352-242-2502
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Fax | 352-242-0316
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3047
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License Number State | FL
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