Provider Demographics
NPI:1477562601
Name:FLETCHER, RENEE HOPE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:HOPE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:HOPE
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:8466 LOCKWOOD RIDGE RD
Mailing Address - Street 2:#160
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2951
Mailing Address - Country:US
Mailing Address - Phone:941-228-0270
Mailing Address - Fax:941-460-5448
Practice Address - Street 1:8466 LOCKWOOD RIDGE RD
Practice Address - Street 2:# 160
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2951
Practice Address - Country:US
Practice Address - Phone:941-228-0270
Practice Address - Fax:941-460-5448
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005908363LG0600X
FLARNP 3186252363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9637448Medicaid
WA9637448Medicaid
FLCD707ZMedicare PIN