Provider Demographics
NPI:1053422766
Name:HENLON, TELSA DAWN (ARNP)
Entity type:Individual
Prefix:MS
First Name:TELSA
Middle Name:DAWN
Last Name:HENLON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 SW 124TH WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2533
Mailing Address - Country:US
Mailing Address - Phone:954-437-1802
Mailing Address - Fax:305-355-2161
Practice Address - Street 1:1821 SW 124TH WAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2533
Practice Address - Country:US
Practice Address - Phone:954-437-1802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1466692363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner