Provider Demographics
NPI:1396186102
Name:TICE, KENDRA J (RN, MSN,DNP)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:J
Last Name:TICE
Suffix:
Gender:F
Credentials:RN, MSN,DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4732 POLARIS ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-5008
Mailing Address - Country:US
Mailing Address - Phone:904-381-0512
Mailing Address - Fax:904-381-0878
Practice Address - Street 1:4732 POLARIS ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-5008
Practice Address - Country:US
Practice Address - Phone:904-381-0512
Practice Address - Fax:904-381-0878
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9239299163W00000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No174H00000XOther Service ProvidersHealth Educator