Provider Demographics
NPI:1275266728
Name:HENINGER, THEODORE G II (APRN FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:G
Last Name:HENINGER
Suffix:II
Gender:M
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6175 RIVERWALK LN UNIT 4
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3975
Mailing Address - Country:US
Mailing Address - Phone:561-254-1174
Mailing Address - Fax:
Practice Address - Street 1:1335 W INDIANTOWN RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4631
Practice Address - Country:US
Practice Address - Phone:561-263-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020469363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily