Provider Demographics
NPI:1033684873
Name:HENDRICKS, MATTHEW M (PA-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 E. OAKLAND PARK BOULEVARD
Mailing Address - Street 2:S. 201
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306
Mailing Address - Country:US
Mailing Address - Phone:954-564-0040
Mailing Address - Fax:
Practice Address - Street 1:2838 E. OAKLAND PARK BOULEVARD
Practice Address - Street 2:S. 201
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306
Practice Address - Country:US
Practice Address - Phone:954-564-0040
Practice Address - Fax:954-217-3222
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9111716363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant