Provider Demographics
NPI:1114760121
Name:SCHROEDER, CARLY ANNE (RN)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:ANNE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:ANNE
Other - Last Name:SANSOUCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3348 ANTICA ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-1500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3348 ANTICA ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-1500
Practice Address - Country:US
Practice Address - Phone:508-330-2263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9530122163WN0002X
FL11040847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care