Provider Demographics
NPI:1730406133
Name:HENDRICKS, SOPHIA NADINE (FNP)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:NADINE
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 NC HIGHWAY 55 W
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365-8527
Mailing Address - Country:US
Mailing Address - Phone:919-658-5900
Mailing Address - Fax:919-658-0101
Practice Address - Street 1:595 BIGLERVILLE RD
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-8002
Practice Address - Country:US
Practice Address - Phone:301-593-1315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012001363LF0000X, 363L00000X
NC5006499363LF0000X
NYF336105363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF1209090OtherAANP CERTIFICATION