1134143860 NPI number — MS. VERA O ANDERSON ARNP

Table of content: MS. VERA O ANDERSON ARNP (NPI 1134143860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134143860 NPI number — MS. VERA O ANDERSON ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
VERA
Provider Middle Name:
O
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134143860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 W COLUMBIA ST
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32806-6100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-852-2760
Provider Business Mailing Address Fax Number:
321-843-6729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 W COLUMBIA ST
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32806-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-852-2760
Provider Business Practice Location Address Fax Number:
321-843-6729
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP2654152 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2200X , with the licence number: 2654152 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004784300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: ARNP2654152 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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