MEDICARE: ANABEL P PEREDA APRN

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	363L00000X	Nurse Practitioner	APRN3380252	FL
2	363LF0000X	Family Nurse Practitioner	APRN3380252	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01165559	OTHER	FL	FL RR MEDICARE
3	E5526T	OTHER	FL	FL MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1134112303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANABEL P PEREDA APRN

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:	321-361-5534
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 N SYKES CREEK PKWY STE 301
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3490
Country	:	US
Telephone Number	:	321-361-5534
Fax Number	:	321-361-5543

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	05/09/2024

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Directions to “ ANABEL P PEREDA APRN” Practice Location

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