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General NPI Number Information
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NPI Number | 1508132085
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Entity Type | Individual
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Provider Name | ROSANNE MARIE HENRY M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 5005 PORT ST JOHN PKWY STE 2300
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City | PORT ST JOHN
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State | FL
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Zip | 32927-4305
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Country | US
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Telephone | 321-633-8663
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Fax | 321-633-8618
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Provider Business Mailing Address
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Address Line | 805 CENTURY MEDICAL DR STE C
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City | TITUSVILLE
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State | FL
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Zip | 32796-2100
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Country | US
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Telephone | 321-268-6264
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Fax | 321-268-6273
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME127424
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License Number State | FL
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