Provider Demographics
NPI:1447594973
Name:LINDA M. ROSS PEDERSEN, PA
Entity Type:Organization
Organization Name:LINDA M. ROSS PEDERSEN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSS PEDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:239-357-8256
Mailing Address - Street 1:1039 SAND CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:SANIBEL
Mailing Address - State:FL
Mailing Address - Zip Code:33957-3614
Mailing Address - Country:US
Mailing Address - Phone:239-357-8256
Mailing Address - Fax:239-395-3375
Practice Address - Street 1:3700 CENTRAL AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7649
Practice Address - Country:US
Practice Address - Phone:239-275-0665
Practice Address - Fax:239-275-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1927642367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304513700Medicaid
430051711OtherRAILROAD MEDICARE
FLG0375OtherBC/BS FL
FL304513700Medicaid