Revonda D Peterson, ARNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

11015620 Issued in FL

Practice address

5420 Chiquita Blvd S Apt C
Cape Coral, FL 33914-7418

Phone

(239) 240-0040

NPI assigned

Oct 19, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Revonda D Peterson Professional name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Elitemedcare

  • Geriatric Medicine (Family Medicine) Physician
  • Naples, FL
  • NPI 1841018553
  Medicare reassignment NPD
• M & H Med Housecalls, LLC

  • Internal Medicine Physician
  • Fort Myers, FL
  • NPI 1427548304

  Gerontology

  Medicare reassignment NPD
• Cape Coral Hospitalists Inc

  • Internal Medicine Physician
  • Fort Myers, FL
  • NPI 1336209790
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778457600000",
    "number": "1891458683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5420 CHIQUITA BLVD S APT C",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339147418",
            "telephone_number": "239-240-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5420 CHIQUITA BLVD S APT C",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339147418",
            "telephone_number": "239-240-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "REVONDA",
        "middle_name": "D",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-19",
        "last_updated": "2026-05-11",
        "certification_date": "2021-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "11015620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REVONDA",
            "last_name": "PETERSON",
            "middle_name": "D",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Tashira Persia, MD
• Personal Touch Therapy and Wellness
• Haniel Perugorria
• Dirk Peterson, M.D.
• Kenya Peterson
• Erica Petithomme
• Kathie-Lee Petsch, CCC-SLP
• Nathan Samuel Pettit, MS, LMHC, MCAP
• Gabrielle Pfeffer
• Ngoc Han Thi Pham, DPM

• Gerontology Nurse Practitioner in Cape Coral, FL
• Providers in Cape Coral, FL by specialty
• Gerontology Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.