Provider Demographics
NPI:1205363405
Name:HENDRICK, ALEXANDER DAFFRON (NP)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:DAFFRON
Last Name:HENDRICK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 WESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-5150
Mailing Address - Country:US
Mailing Address - Phone:434-882-1747
Mailing Address - Fax:
Practice Address - Street 1:3025 BERKMAR DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1456
Practice Address - Country:US
Practice Address - Phone:434-973-1833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174640363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily