Provider Demographics
NPI:1275233389
Name:MENDENHALL, MIKAYLA CORINNE (BSN)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:CORINNE
Last Name:MENDENHALL
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 N 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4013
Mailing Address - Country:US
Mailing Address - Phone:305-899-3246
Mailing Address - Fax:954-367-8697
Practice Address - Street 1:421 N 21ST AVE STE 1A
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4013
Practice Address - Country:US
Practice Address - Phone:305-899-3246
Practice Address - Fax:954-367-8697
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9579886367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered