Provider Demographics
NPI:1184917866
Name:FREDRICKSON, ARIANNE M (PA-C)
Entity type:Individual
Prefix:
First Name:ARIANNE
Middle Name:M
Last Name:FREDRICKSON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 RUDDER RUN
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4306
Mailing Address - Country:US
Mailing Address - Phone:715-456-1480
Mailing Address - Fax:
Practice Address - Street 1:1810 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2015
Practice Address - Country:US
Practice Address - Phone:843-781-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPA3023363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant