Healthcare Provider Details

I. General information

NPI: 1881069797
Provider Name (Legal Business Name): CHAD M HENDERSON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 3RD AVE W STE 110
BRADENTON FL
34205-8641
US

IV. Provider business mailing address

100 3RD AVE W STE 110
BRADENTON FL
34205-8641
US

V. Phone/Fax

Practice location:
  • Phone: 941-708-9555
  • Fax: 941-708-5465
Mailing address:
  • Phone: 941-708-9555
  • Fax: 941-708-5465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006007A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: