Provider Demographics
NPI:1497297865
Name:FLANEGAN, RENEE (FNP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:FLANEGAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:823 82ND PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4607
Practice Address - Country:US
Practice Address - Phone:843-449-1010
Practice Address - Fax:843-497-6171
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20535363L00000X
SCAPN.20535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01850776OtherRR MEDICARE
SC1359822OtherWELLCARE
SCNP4346Medicaid
SC80106076OtherSELECT HEALTH MEDICARE LINE OF BUSINESS
SC30297026OtherSELECT HEALTH MEDICAID LINE OF BUSINESS
SC5957893OtherAETNA
SC6396135OtherUNITED