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General NPI Number Information
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NPI Number | 1932170263
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Entity Type | Individual
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Provider Name | LISA C HENDRICKS M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 05/14/2020
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Provider Practice Location Address
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Address Line | 1713 HWY 441 N STE F
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City | OKEECHOBEE
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State | FL
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Zip | 34972
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Country | US
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Telephone | 863-763-8000
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Fax | 863-763-8212
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Provider Business Mailing Address
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Address Line | 1713 HWY 441 N STE F
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City | OKEECHOBEE
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State | FL
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Zip | 34972
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Country | US
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Telephone | 863-763-8000
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Fax | 863-763-8212
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 01046928A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | ME144643
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License Number State | FL
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