Provider Demographics
NPI:1467232991
Name:HENDERSON, KAMARRA SEMONNE (APRN)
Entity type:Individual
Prefix:MS
First Name:KAMARRA
Middle Name:SEMONNE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 NW FLORESTA DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1508
Mailing Address - Country:US
Mailing Address - Phone:561-856-9906
Mailing Address - Fax:
Practice Address - Street 1:773 NW FLORESTA DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1508
Practice Address - Country:US
Practice Address - Phone:561-856-9906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily