Provider Demographics
NPI:1841289626
Name:FONDREN, RENEE CECILE (APRN-C)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:CECILE
Last Name:FONDREN
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4759 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4945
Mailing Address - Country:US
Mailing Address - Phone:727-841-8772
Mailing Address - Fax:727-848-5897
Practice Address - Street 1:4759 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4945
Practice Address - Country:US
Practice Address - Phone:727-841-8772
Practice Address - Fax:727-848-5897
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1268292363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306711400Medicaid
FLY065NOtherBCBS
FLY065NOtherBCBS
Q33407Medicare UPIN
FLY065NYMedicare PIN