MEDICARE: MICHAEL LEWIS HENRY NP-C, ACNPC-AG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	30077	TN
2	363LF0000X	Family Nurse Practitioner	APRN11026468	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346918786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LEWIS HENRY NP-C, ACNPC-AG

Provider Business Mailing Address
First Line	:	PO BOX 746649
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6649
Country	:	US
Telephone Number	:	904-202-2092
Fax Number	:	904-376-4075

Provider Business Practice Location Address
First Line	:	841 PRUDENTIAL DR FL 10
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8329
Country	:	US
Telephone Number	:	904-398-5404
Fax Number	:	904-391-5545

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2021
Last Update Date	:	06/01/2026

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