Provider Demographics
NPI:1093413825
Name:RENAUD, ERIN E
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:RENAUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15451 NW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-8278
Mailing Address - Country:US
Mailing Address - Phone:352-221-1574
Mailing Address - Fax:
Practice Address - Street 1:303 SE 17TH ST STE 309
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4423
Practice Address - Country:US
Practice Address - Phone:352-221-1574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily