Provider Demographics
NPI:1780240218
Name:HENDRY, ELLEN MIDDLETON (PA-C)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MIDDLETON
Last Name:HENDRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NW 76TH DR STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6663
Mailing Address - Country:US
Mailing Address - Phone:352-332-4051
Mailing Address - Fax:352-332-2966
Practice Address - Street 1:350 NW 76TH DR STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6663
Practice Address - Country:US
Practice Address - Phone:352-332-4051
Practice Address - Fax:352-332-2966
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112395207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty