Healthcare Provider Details

I. General information

NPI: 1487033072
Provider Name (Legal Business Name): RAE ANN HIGH MS, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21942 EDGEWATER DR
PORT CHARLOTTE FL
33952-9723
US

IV. Provider business mailing address

21942 EDGEWATER DR
PORT CHARLOTTE FL
33952-9723
US

V. Phone/Fax

Practice location:
  • Phone: 941-505-2100
  • Fax: 941-505-6100
Mailing address:
  • Phone: 941-505-2100
  • Fax: 941-505-6100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP 1014742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: