Provider Demographics
NPI:1881853463
Name:FREDERICK, PAULINE (FNP)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9219
Mailing Address - Fax:239-343-9218
Practice Address - Street 1:12600 CREEKSIDE LN STE 6
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3353
Practice Address - Country:US
Practice Address - Phone:239-343-9219
Practice Address - Fax:239-343-9218
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004371363LF0000X
FLARNP9446475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily