Provider Demographics
NPI:1528016706
Name:DEPAUL, RHONA HOLGANZA (MD)
Entity Type:Individual
Prefix:DR
First Name:RHONA
Middle Name:HOLGANZA
Last Name:DEPAUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RHONA
Other - Middle Name:S
Other - Last Name:HOLGANZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:941-629-2922
Mailing Address - Fax:941-629-1311
Practice Address - Street 1:2525 HARBOR BLVD STE 204
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5342
Practice Address - Country:US
Practice Address - Phone:941-629-2922
Practice Address - Fax:941-629-1311
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83564208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112034700Medicaid
FL262750700Medicaid
FL06350OtherBLUE CROSS