Provider Demographics
NPI:1871182824
Name:HENWOOD, DANI ROSE
Entity Type:Individual
Prefix:
First Name:DANI
Middle Name:ROSE
Last Name:HENWOOD
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 1:3210 N ANDREWS AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-2116
Mailing Address - Country:US
Mailing Address - Phone:866-550-2212
Mailing Address - Fax:
Practice Address - Street 1:380 W PALMETTO PARK RD UNIT 513
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-6722
Practice Address - Country:US
Practice Address - Phone:724-977-6338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113961363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant