Healthcare Provider Details

I. General information

NPI: 1194435974
Provider Name (Legal Business Name): KENDALL KOHL THURSTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 SE 18TH ST STE 1102
OCALA FL
34471-5447
US

IV. Provider business mailing address

2335 SE 14TH ST
OCALA FL
34471-2644
US

V. Phone/Fax

Practice location:
  • Phone: 352-512-0092
  • Fax: 352-512-0093
Mailing address:
  • Phone: 772-263-6068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11042444
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: