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NPI Code Detail

MEDICARE: MR. JONATHAN CLEON HENDRICKS PA-C

MEDICARE: MR. JONATHAN CLEON HENDRICKS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA9101920FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033185699
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JONATHAN CLEON HENDRICKS PA-C
Provider Business Mailing Address
First Line : 4131 MATIA DR
Second Line :
City : FERNDALE
State : WA
Zip : 98248-9539
Country : US
Telephone Number : 523-561-2513
Fax Number :
Provider Business Practice Location Address
First Line : 636 DEL PRADO BOULEVARD
Second Line :
City : CAPE CORAL
State : FL
Zip : 33990-2695
Country : US
Telephone Number : 239-424-2222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2006
Last Update Date : 11/21/2024

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