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General NPI Number Information
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NPI Number | 1033185699
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Entity Type | Individual
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Provider Name | JONATHAN CLEON HENDRICKS PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/24/2006
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 636 DEL PRADO BOULEVARD
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City | CAPE CORAL
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State | FL
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Zip | 33990-2695
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Country | US
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Telephone | 239-424-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 4131 MATIA DR
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City | FERNDALE
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State | WA
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Zip | 98248-9539
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Country | US
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Telephone | 523-561-2513
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9101920
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License Number State | FL
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