Healthcare Provider Details

I. General information

NPI: 1437400991
Provider Name (Legal Business Name): ANN M. VIDRICK MSN, RN, ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 DEL PRADO BLVD S
CAPE CORAL FL
33990-3623
US

IV. Provider business mailing address

6321 DANIELS PKWY STE 200
FORT MYERS FL
33912-4710
US

V. Phone/Fax

Practice location:
  • Phone: 239-217-8070
  • Fax: 239-217-8069
Mailing address:
  • Phone: 239-416-8101
  • Fax: 239-402-8601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number13851
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11025621
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: