Provider Demographics
NPI:1033625504
Name:HENDRIX, ELIZABETH ASHLEY (HIS)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ASHLEY
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 ATLANTIC DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-2435
Mailing Address - Country:US
Mailing Address - Phone:850-630-1330
Mailing Address - Fax:
Practice Address - Street 1:3863 S NOVA RD STE B
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4959
Practice Address - Country:US
Practice Address - Phone:386-310-4861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5271237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist