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General NPI Number Information
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NPI Number | 1962938894
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Entity Type | Organization
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Legal Business Name | MICHELLE HENNE, M.D., P.A.
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 5535 CYPRESS GARDENS BLVD STE 270
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City | WINTER HAVEN
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State | FL
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Zip | 33884-2241
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Country | US
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Telephone | 863-401-4401
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Fax | 863-410-1108
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Provider Business Mailing Address
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Address Line | 5535 CYPRESS GARDENS BLVD STE 270
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City | WINTER HAVEN
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State | FL
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Zip | 33884-2241
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Country | US
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Telephone | 863-401-4401
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Fax | 863-410-1108
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHELLE HENNE
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Credential | M.D.
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Telephone | 863-401-4401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME121120
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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