MEDICARE: MRS. ANNE M KECK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	001876	CT
2	363AM0700X	Medical Physician Assistant	001876	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588631469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNE M KECK PA-C

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE STE 200
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9328
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:	239-599-2612

Provider Business Practice Location Address
First Line	:	2450 TAMIAMI TRL STE A
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-3922
Country	:	US
Telephone Number	:	941-624-2704
Fax Number	:	941-627-6066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	01/12/2026

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