Peterson, Revonda D
Peterson, Revonda D is an sole proprietor health care provider with primary practice located at 5420 Chiquita Blvd S Apt C , Cape Coral FL 33914-7418. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Gerontology, which is considered as her primary health care specialty. Peterson, Revonda D can be contacted via phone (239) 240-0040.Contact Information
Primary practice address
5420 Chiquita Blvd S Apt C
Cape Coral FL 33914-7418
Phone: (239) 240-0040
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Gerontology | 363LG0600X | 11015620 | Florida |
Profile Details
| NPI number | 1891458683 |
|---|---|
| LBN Legal business name | Peterson, Revonda D |
| Credentials | ARNP |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 19th, 2021 |
| Last updated | Oct 19th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891458683 | NPPES |
| Florida | MEDICAID | 03141975 |
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