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General NPI Number Information
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NPI Number | 1700128832
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Entity Type | Individual
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Provider Name | GWENDOLYN YOUNG HENSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/27/2013
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 611 DRUID RD E STE 511
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City | CLEARWATER
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State | FL
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Zip | 33756-3942
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Country | US
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Telephone | 727-601-4007
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Fax |
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Provider Business Mailing Address
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Address Line | 601 S HARBOUR ISLAND BLVD STE 200
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City | TAMPA
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State | FL
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Zip | 33602-5925
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Country | US
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Telephone | 727-322-3439
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 20467
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN1313
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License Number State | FL
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