MEDICARE: TOBIAS FREDEKING

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	363LF0000X	Family Nurse Practitioner	11003659	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	:	1497877344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOBIAS FREDEKING

Provider Business Mailing Address
First Line	:	2009 PINE ISLAND CIR
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-7880
Country	:	US
Telephone Number	:	209-605-6356
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 PINE ISLAND CIR
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-7880
Country	:	US
Telephone Number	:	209-605-6356
Fax Number	:

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	10/04/2019

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Directions to “ TOBIAS FREDEKING ” Practice Location

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