Provider Demographics
NPI:1629504527
Name:LEDERER, MARGARET ELLEN (ARNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELLEN
Last Name:LEDERER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 E BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4207
Mailing Address - Country:US
Mailing Address - Phone:850-522-5490
Mailing Address - Fax:850-522-5491
Practice Address - Street 1:633 E BALDWIN RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4207
Practice Address - Country:US
Practice Address - Phone:850-522-5490
Practice Address - Fax:850-522-5491
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1864992363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health