Provider Demographics
NPI:1205296407
Name:KENDRICK, CHRISTIAN ADAM (ARNP)
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:ADAM
Last Name:KENDRICK
Suffix:
Gender:M
Credentials:ARNP
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Other - First Name:
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Mailing Address - Street 1:1286 FLORIDA AVE S STE 1
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2400
Mailing Address - Country:US
Mailing Address - Phone:321-636-7780
Mailing Address - Fax:321-633-3043
Practice Address - Street 1:1286 FLORIDA AVE S STE 1
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2400
Practice Address - Country:US
Practice Address - Phone:321-636-7780
Practice Address - Fax:321-633-3043
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9320972363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100869800Medicaid
FLJG234ZOtherMEDICARE