Provider Demographics
NPI:1679317036
Name:HENRY, LANESE (CNM, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LANESE
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:CNM, FNP-BC
Other - Prefix:MS
Other - First Name:LANESE
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1307 S PINE AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6543
Mailing Address - Country:US
Mailing Address - Phone:352-368-2238
Mailing Address - Fax:
Practice Address - Street 1:1307 S PINE AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6543
Practice Address - Country:US
Practice Address - Phone:352-368-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11032373363LF0000X
FLAPRN11032373367A00000X
FL09333367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily