Provider Demographics
NPI:1720403074
Name:HENDRICKS, RHONDA RENEA (APRN)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:RENEA
Last Name:HENDRICKS
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:P.O. BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-2755
Mailing Address - Fax:239-424-2756
Practice Address - Street 1:708 DEL PRADO BLVD S STE 6
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2661
Practice Address - Country:US
Practice Address - Phone:239-424-2755
Practice Address - Fax:239-424-2756
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9169032364SM0705X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010784900Medicaid