Provider Demographics
NPI:1396173290
Name:REDFERN, ANN MARIE (ARNP, PNP-BC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:REDFERN
Suffix:
Gender:F
Credentials:ARNP, PNP-BC
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:SLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:11150 CAMERON CT
Mailing Address - Street 2:#4-304
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4173
Mailing Address - Country:US
Mailing Address - Phone:813-340-6816
Mailing Address - Fax:
Practice Address - Street 1:21097 NE 27TH CT
Practice Address - Street 2:SUITE 205
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1204
Practice Address - Country:US
Practice Address - Phone:305-682-9877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9315780363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009955300Medicaid
FLHY286ZMedicare PIN