Provider Demographics
NPI:1063725067
Name:OVERDIEK, RONDA MICHELE (CRNA)
Entity type:Individual
Prefix:MS
First Name:RONDA
Middle Name:MICHELE
Last Name:OVERDIEK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:RONDA
Other - Middle Name:
Other - Last Name:THORPE, DIMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:904-697-4127
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1717 S. ORANGE AVE., SUITE 100
Practice Address - Street 2:NEMOURS CHILDRENS CLINIC, ORLANDO
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2946
Practice Address - Country:US
Practice Address - Phone:407-650-7715
Practice Address - Fax:407-650-7124
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.11500-NA367500000X
FLARNP9342792367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered