Provider Demographics
NPI:1134713530
Name:REDONDO, ANNALIESE J (APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:ANNALIESE
Middle Name:J
Last Name:REDONDO
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11051 OAKSHORE LN
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5449
Mailing Address - Country:US
Mailing Address - Phone:573-528-1943
Mailing Address - Fax:
Practice Address - Street 1:706 E GRAND HWY
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3708
Practice Address - Country:US
Practice Address - Phone:352-557-4965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010931363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics