Provider Demographics
NPI:1003084278
Name:HENAO, HENRY (MSN, ARNP, FNP-BC)
Entity type:Individual
Prefix:PROF
First Name:HENRY
Middle Name:
Last Name:HENAO
Suffix:
Gender:M
Credentials:MSN, ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 SW 107TH AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2526
Mailing Address - Country:US
Mailing Address - Phone:305-490-0494
Mailing Address - Fax:
Practice Address - Street 1:11200 SW 8TH STREET ACADEMIC HEALTH CENTER 3, 305A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33199-2924
Practice Address - Country:US
Practice Address - Phone:305-348-1082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLEMT 304782146N00000X
FLARNP 9219002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL548ZMedicare UPIN