1700837713 NPI number — MRS. ANN CARROLL BODE BIDDISON APRN

Table of content: MRS. ANN CARROLL BODE BIDDISON APRN (NPI 1700837713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700837713 NPI number — MRS. ANN CARROLL BODE BIDDISON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIDDISON
Provider First Name:
ANN
Provider Middle Name:
CARROLL BODE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700837713
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12730 NEW BRITTANY BLVD STE 602
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33907-4690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-275-5522
Provider Business Mailing Address Fax Number:
239-275-4464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1255 VISCAYA PKWY STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPE CORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33990-3290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-574-1988
Provider Business Practice Location Address Fax Number:
239-574-1435
Provider Enumeration Date:
05/15/2006

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: 363L00000X , with the licence number:  APRN949272 , 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: 304318500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y7320 . This is a "FLORIDA BLUE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 102755000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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