Provider Demographics
NPI:1881287142
Name:GILL, KENDALL A (APRN)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:A
Last Name:GILL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:A
Other - Last Name:HODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3001 EXECUTIVE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-5323
Mailing Address - Country:US
Mailing Address - Phone:727-347-0005
Mailing Address - Fax:727-541-6558
Practice Address - Street 1:7017 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7559
Practice Address - Country:US
Practice Address - Phone:727-384-2016
Practice Address - Fax:727-343-3791
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11009658363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner