Individual
RENEE FLANEGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
823 82ND PKWY, MYRTLE BEACH, SC 29572-4607
(843) 449-1010
(843) 497-6171
Mailing address
2160 COLONIAL BLVD, ATTN: PAYER CONTRACTING & RELATIONS, FORT MYERS, FL 33907-1410
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
20535
SC
363LF0000X
Family Nurse Practitioner
Primary
APN.20535
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1359822
WELLCARE
SC
01
—
30297026
SELECT HEALTH MEDICAID LINE OF BUSINESS
SC
01
—
5957893
AETNA
SC
01
—
6396135
UNITED
SC
01
—
80106076
SELECT HEALTH MEDICARE LINE OF BUSINESS
SC
05
—
NP4346
—
SC
01
—
P01850776
RR MEDICARE
SC
Enumeration date
11/16/2016
Last updated
09/21/2017
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