Provider Demographics
NPI:1972654077
Name:HENNING, EMILY MARIE (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:HENNING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 SLEEPY OAK LN
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-8626
Mailing Address - Country:US
Mailing Address - Phone:386-717-0983
Mailing Address - Fax:
Practice Address - Street 1:2401 SLEEPY OAK LN
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-8626
Practice Address - Country:US
Practice Address - Phone:386-717-0983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6629YMedicare PIN