Healthcare Provider Details

I. General information

NPI: 1205296407
Provider Name (Legal Business Name): CHRISTIAN ADAM KENDRICK ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 12/09/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1286 FLORIDA AVE S STE 1
ROCKLEDGE FL
32955-2400
US

IV. Provider business mailing address

1286 FLORIDA AVE S STE 1
ROCKLEDGE FL
32955-2400
US

V. Phone/Fax

Practice location:
  • Phone: 321-636-7780
  • Fax: 321-633-3043
Mailing address:
  • Phone: 321-636-7780
  • Fax: 321-633-3043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9320972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: