Provider Demographics
NPI:1134112303
Name:PEREDA, ANABEL P (APRN)
Entity type:Individual
Prefix:
First Name:ANABEL
Middle Name:P
Last Name:PEREDA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-361-5534
Mailing Address - Fax:
Practice Address - Street 1:220 N SYKES CREEK PKWY STE 301
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3490
Practice Address - Country:US
Practice Address - Phone:321-361-5534
Practice Address - Fax:321-361-5543
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3380252363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01165559OtherFL RR MEDICARE
FL101477400Medicaid
FLE5526TOtherFL MEDICARE
FL101477400Medicaid