Basic Information
| Provider Information | |||||||||
| NPI: | 1134713530 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REDONDO | ||||||||
| FirstName: | ANNALIESE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | APRN, CPNP-PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11051 OAKSHORE LN | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347115449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5735281943 | ||||||||
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| Practice Location | |||||||||
| Address1: | 706 E GRAND HWY | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347113708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525574965 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2021 | ||||||||
| LastUpdateDate: | 11/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | APRN11010931 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.