MEDICARE: SANDRA DIANE RENNE PA

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	PA 3668	FL

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	:	1689674350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA DIANE RENNE PA

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE
Second Line	:	FL 2
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	239-449-8381
Fax Number	:

Provider Business Practice Location Address
First Line	:	6020 GREEN BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34116-4826
Country	:	US
Telephone Number	:	239-449-8381
Fax Number	:

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	12/23/2019

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Directions to “ SANDRA DIANE RENNE PA” Practice Location

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