Provider Demographics
NPI:1518460609
Name:HENN, ADRIENNE P
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:P
Last Name:HENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95024 RAINTREE LN
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-7105
Mailing Address - Country:US
Mailing Address - Phone:513-557-6415
Mailing Address - Fax:
Practice Address - Street 1:95024 RAINTREE LN
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-7105
Practice Address - Country:US
Practice Address - Phone:513-557-6415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1000691243747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant