Individual
REVONDA D PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
5420 CHIQUITA BLVD S APT C, CAPE CORAL, FL 33914-7418
(239) 240-0040
Mailing address
5420 CHIQUITA BLVD S APT C, CAPE CORAL, FL 33914-7418
(239) 240-0040
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
11015620
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03141975
—
FL
Enumeration date
10/19/2021
Last updated
05/11/2026
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