MEDICARE: SUMMER RAE HENRY APRN

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	363LF0000X	Family Nurse Practitioner	11033493	FL
2	363L00000X	Nurse Practitioner	APRN11033493	FL

General Provider Information

NPI Number	:	1417735630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMMER RAE HENRY APRN

Provider Business Mailing Address
First Line	:	200 S FEDERAL HWY APT 203
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-3698
Country	:	US
Telephone Number	:	228-234-7946
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 S FEDERAL HWY APT 203
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-3698
Country	:	US
Telephone Number	:	228-234-7946
Fax Number	:

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

Provider Enumeration Date	:	09/19/2023
Last Update Date	:	03/04/2026

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