Provider Demographics
NPI:1043917982
Name:HENRY, DUNSTAN M (APRN)
Entity type:Individual
Prefix:
First Name:DUNSTAN
Middle Name:M
Last Name:HENRY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3042 N FEDERAL HWY STE 305
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1400
Mailing Address - Country:US
Mailing Address - Phone:954-417-5220
Mailing Address - Fax:866-479-4761
Practice Address - Street 1:3042 N FEDERAL HWY STE 305
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1400
Practice Address - Country:US
Practice Address - Phone:954-417-5220
Practice Address - Fax:866-479-4761
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11034444363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN110034444OtherMEDICAL LICENSE