MEDICARE: ANGELA D HENN

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1851433676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA D HENN

Provider Business Mailing Address
First Line	:	228 PONTE VEDRA PARK DR
Second Line	:	SUITE 800
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-6613
Country	:	US
Telephone Number	:	904-280-0081
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 PONTE VEDRA PARK DR
Second Line	:	SUITE 800
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-6613
Country	:	US
Telephone Number	:	904-280-0081
Fax Number	:

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/08/2007

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Directions to “ ANGELA D HENN ” Practice Location

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