Provider Demographics
NPI:1316902505
Name:HENSLEY, LOREN ANN (DO)
Entity type:Individual
Prefix:DR
First Name:LOREN
Middle Name:ANN
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LOREN
Other - Middle Name:ANN
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:26907 FOGGY CREEK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6778
Mailing Address - Country:US
Mailing Address - Phone:813-501-4468
Mailing Address - Fax:813-501-8620
Practice Address - Street 1:26907 FOGGY CREEK RD STE 102
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544
Practice Address - Country:US
Practice Address - Phone:813-501-4468
Practice Address - Fax:813-501-8620
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1933207R00000X
FLOS12462207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1812206000Medicaid
WVH63892Medicare UPIN
WV1812206000Medicaid