Provider Demographics
NPI:1740569151
Name:PRESEAU, RANAE DAWN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:RANAE
Middle Name:DAWN
Last Name:PRESEAU
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:RANAE
Other - Middle Name:DAWN
Other - Last Name:CEREZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2901 58TH AVE N.
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-1326
Mailing Address - Country:US
Mailing Address - Phone:727-822-4300
Mailing Address - Fax:727-456-1399
Practice Address - Street 1:5205 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-1126
Practice Address - Country:US
Practice Address - Phone:813-987-2911
Practice Address - Fax:813-987-2853
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9178890363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004121600Medicaid