Provider Demographics
NPI:1740312511
Name:HENNESSY, DOROTHY (CRNA)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:
Other - Last Name:HALSTEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1214 E CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5453
Mailing Address - Country:US
Mailing Address - Phone:407-896-9500
Mailing Address - Fax:407-896-9585
Practice Address - Street 1:83 W MILLER ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2031
Practice Address - Country:US
Practice Address - Phone:321-843-9792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1919872367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL033435900Medicaid
FLG0211XMedicare PIN
FLG0211WMedicare PIN