Provider Demographics
NPI:1376285411
Name:HENRY, MICHELLE SONG (DNP-FNP)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:SONG
Last Name:HENRY
Suffix:
Gender:F
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 S PINE AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5150
Mailing Address - Country:US
Mailing Address - Phone:352-861-4600
Mailing Address - Fax:
Practice Address - Street 1:2300 S PINE AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5150
Practice Address - Country:US
Practice Address - Phone:352-861-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-09
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR199523363LF0000X
FLAPRN11024024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily