Healthcare Provider Details

I. General information

NPI: 1336077593
Provider Name (Legal Business Name): KENDAL SUZANNE CARROLL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 W GULF TO LAKE HWY
CRYSTAL RIVER FL
34429-7622
US

IV. Provider business mailing address

20693 POWELL RD
DUNNELLON FL
34431-6516
US

V. Phone/Fax

Practice location:
  • Phone: 352-563-2450
  • Fax:
Mailing address:
  • Phone: 352-229-1243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11050400
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: