Provider Demographics
NPI:1952094534
Name:EICKELBERG, KENDYLL (RN)
Entity Type:Individual
Prefix:
First Name:KENDYLL
Middle Name:
Last Name:EICKELBERG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KENDYLL
Other - Middle Name:
Other - Last Name:WILLINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4311 LONG KEY LN APT 19109
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-6991
Mailing Address - Country:US
Mailing Address - Phone:281-839-4319
Mailing Address - Fax:
Practice Address - Street 1:4311 LONG KEY LN APT 19109
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-6991
Practice Address - Country:US
Practice Address - Phone:281-839-4319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9569151163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse