Provider Demographics
NPI:1053340976
Name:HENRIQUEZ, NORMA (MD)
Entity type:Individual
Prefix:DR
First Name:NORMA
Middle Name:
Last Name:HENRIQUEZ
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 1:10201 ARCOS AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-9461
Mailing Address - Country:US
Mailing Address - Phone:239-400-9022
Mailing Address - Fax:855-225-4662
Practice Address - Street 1:10201 ARCOS AVE STE 201
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-9461
Practice Address - Country:US
Practice Address - Phone:239-400-9022
Practice Address - Fax:855-225-4662
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 51542174400000X
FLME515422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009201800Medicaid
FL009201800Medicaid