Healthcare Provider Details

I. General information

NPI: 1417371543
Provider Name (Legal Business Name): KENDRA R. MULHOLLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 SUN N LAKE BLVD STE 102
SEBRING FL
33872-2171
US

IV. Provider business mailing address

4325 SUN N LAKE BLVD STE 102
SEBRING FL
33872-2171
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-1663
  • Fax: 863-386-0162
Mailing address:
  • Phone: 863-382-1663
  • Fax: 863-386-0162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP15548
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCOA15548
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11028828
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: