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General NPI Number Information
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NPI Number | 1275266728
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Entity Type | Individual
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Provider Name | THEODORE G HENINGER II APRN FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 07/01/2022
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 1335 W INDIANTOWN RD
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City | JUPITER
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State | FL
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Zip | 33458-4631
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Country | US
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Telephone | 561-263-7010
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Fax |
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Provider Business Mailing Address
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Address Line | 6175 RIVERWALK LN UNIT 4
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City | JUPITER
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State | FL
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Zip | 33458-3975
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Country | US
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Telephone | 561-254-1174
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11020469
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License Number State | FL
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