Provider Demographics
NPI:1700128832
Name:HENSON, GWENDOLYN YOUNG (MD)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:YOUNG
Last Name:HENSON
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 1:6675 WESTWOOD BLVD STE 475
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6027
Mailing Address - Country:US
Mailing Address - Phone:407-845-0330
Mailing Address - Fax:
Practice Address - Street 1:4700 N HABANA AVE STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7116
Practice Address - Country:US
Practice Address - Phone:407-845-0330
Practice Address - Fax:888-972-1752
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20467208D00000X
FLACN1313208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice