Provider Demographics
NPI:1164756144
Name:HENDERSON, LURA MARIE (ARNP, MSN, AOCNP)
Entity Type:Individual
Prefix:MS
First Name:LURA
Middle Name:MARIE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:ARNP, MSN, AOCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1402
Mailing Address - Country:US
Mailing Address - Phone:813-876-0035
Mailing Address - Fax:
Practice Address - Street 1:4910 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1402
Practice Address - Country:US
Practice Address - Phone:813-876-0035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9246839363L00000X, 163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WX0200XNursing Service ProvidersRegistered NurseOncology