1477562601 NPI number — MS. RENEE HOPE FLETCHER ARNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477562601 NPI number — MS. RENEE HOPE FLETCHER ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLETCHER
Provider First Name:
RENEE
Provider Middle Name:
HOPE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOODMAN
Provider Other First Name:
RENEE
Provider Other Middle Name:
HOPE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477562601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8466 LOCKWOOD RIDGE RD
Provider Second Line Business Mailing Address:
#160
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34243-2951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-228-0270
Provider Business Mailing Address Fax Number:
941-460-5448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8466 LOCKWOOD RIDGE RD
Provider Second Line Business Practice Location Address:
# 160
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34243-2951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-228-0270
Provider Business Practice Location Address Fax Number:
941-460-5448
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  AP30005908 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LG0600X , with the licence number: ARNP 3186252 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9637448 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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