Provider Demographics
NPI:1275521684
Name:REDECKER, NANCY (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:REDECKER
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-6100
Mailing Address - Fax:239-343-9925
Practice Address - Street 1:15901 BASS RD
Practice Address - Street 2:SUITE 283
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3838
Practice Address - Country:US
Practice Address - Phone:239-343-6100
Practice Address - Fax:239-343-9925
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1340882367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340302500Medicaid
FLY2992ZMedicare PIN