Provider Demographics
NPI:1821051764
Name:FREDERIKS, CLAUDINE (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDINE
Middle Name:
Last Name:FREDERIKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:727-322-3439
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:2018 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-4562
Practice Address - Country:US
Practice Address - Phone:239-574-8880
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418450207RG0300X
FLME118563207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001948554Medicaid
PAP00799005OtherRAILROAD MEDICARE
PAH79495Medicare UPIN
PA001948554Medicaid
PAH79495Medicare UPIN
FLHR494ZMedicare PIN