Provider Demographics
NPI:1417331273
Name:HENSON, MARYANA (ARNP)
Entity Type:Individual
Prefix:
First Name:MARYANA
Middle Name:
Last Name:HENSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 OAK MANOR LN. #46
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774
Mailing Address - Country:US
Mailing Address - Phone:727-504-2792
Mailing Address - Fax:727-499-9559
Practice Address - Street 1:3600 OAK MANOR LN APT 46
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-1214
Practice Address - Country:US
Practice Address - Phone:727-489-3305
Practice Address - Fax:727-499-9559
Is Sole Proprietor?:No
Enumeration Date:2015-07-11
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9308838363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner