Provider Demographics
NPI:1740647007
Name:MEDRANO, KENDRA LYNNE (PA)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:LYNNE
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10205 GROVE LN
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-4009
Mailing Address - Country:US
Mailing Address - Phone:954-608-3206
Mailing Address - Fax:
Practice Address - Street 1:4800 NE 20TH TER
Practice Address - Street 2:STE 115
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4510
Practice Address - Country:US
Practice Address - Phone:954-776-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant