Provider Demographics
NPI:1700850575
Name:ROSS PEDERSEN, LINDA M (ARNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:ROSS PEDERSEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:M
Other - Last Name:ROSS PEDERSEN, PA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:1039 SAND CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:SANIBEL
Mailing Address - State:FL
Mailing Address - Zip Code:33957-3614
Mailing Address - Country:US
Mailing Address - Phone:239-357-8256
Mailing Address - Fax:239-395-3375
Practice Address - Street 1:12511 WORLD PLAZA LN
Practice Address - Street 2:BLDG 50
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3991
Practice Address - Country:US
Practice Address - Phone:239-939-2622
Practice Address - Fax:239-939-0151
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1927642367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304513700Medicaid
430051711OtherRAILROAD MEDICARE
FLG0375OtherBC/BS FL
FLG0375OtherBC/BS FL
591783920OtherEIN