Healthcare Provider Details

I. General information

NPI: 1841187606
Provider Name (Legal Business Name): SETH HENDRICKS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-9304
US

IV. Provider business mailing address

548 TURKEY CRK
ALACHUA FL
32615-9304
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6438
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number1065
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: