Provider Demographics
NPI:1750013843
Name:KENDRICK, SUMERLYN (ARNP)
Entity Type:Individual
Prefix:
First Name:SUMERLYN
Middle Name:
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 KENT DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-7825
Mailing Address - Country:US
Mailing Address - Phone:334-714-8889
Mailing Address - Fax:
Practice Address - Street 1:112 ORANGE AVE STE 200
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4338
Practice Address - Country:US
Practice Address - Phone:386-267-0831
Practice Address - Fax:386-267-0796
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020408363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily