MEDICARE: LEIDY MARCELA HENAO ARNP, PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11005801	FL

General Provider Information

NPI Number	:	1700416377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIDY MARCELA HENAO ARNP, PMHNP

Provider Business Mailing Address
First Line	:	531 N 71ST TER
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-7338
Country	:	US
Telephone Number	:	305-988-9010
Fax Number	:	954-932-5087

Provider Business Practice Location Address
First Line	:	7900 NW 33RD ST STE 101
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2209
Country	:	US
Telephone Number	:	305-988-9010
Fax Number	:	954-932-5087

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

Provider Enumeration Date	:	01/22/2020
Last Update Date	:	05/27/2026

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