Provider Demographics
NPI:1033729546
Name:ANDERSON HEALTHCARE MASTERS LLC
Entity Type:Organization
Organization Name:ANDERSON HEALTHCARE MASTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:904-909-1227
Mailing Address - Street 1:7643 GATE PKWY STE 104-523
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3092
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:904-253-3492
Practice Address - Street 1:3390 KORI RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-2419
Practice Address - Country:US
Practice Address - Phone:904-638-3511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty