Provider Demographics
NPI:1598543266
Name:WARNER, RAE ANN NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:RAE ANN
Middle Name:NICOLE
Last Name:WARNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RAE ANN
Other - Middle Name:NICOLE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2720 W ROYAL PALM DR
Mailing Address - Street 2:
Mailing Address - City:CITRUS SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34434-3337
Mailing Address - Country:US
Mailing Address - Phone:352-286-5265
Mailing Address - Fax:
Practice Address - Street 1:11371 N WILLIAMS ST STE 4
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-8362
Practice Address - Country:US
Practice Address - Phone:844-797-8425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily