Provider Demographics
NPI:1033840806
Name:PREMO, ANTHONY ATWOOD (APRN, AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ATWOOD
Last Name:PREMO
Suffix:
Gender:M
Credentials:APRN, AGACNP-BC
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Other - Middle Name:
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Mailing Address - Street 1:14785 OLD SAINT AUGUSTINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-7407
Mailing Address - Country:US
Mailing Address - Phone:904-456-0017
Mailing Address - Fax:904-456-0018
Practice Address - Street 1:14785 OLD SAINT AUGUSTINE RD STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-7407
Practice Address - Country:US
Practice Address - Phone:904-456-0017
Practice Address - Fax:904-456-0018
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020380363LA2100X, 363L00000X, 363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1033840806OtherHUMANA MILITARY
FL1033840806OtherPRIME HEALTH SERVICES, INC.
FL1033840806OtherPARADIGM
FL759044500OtherCSNI - DEPT OF LABOR
FLC13FKOtherBCBS
FL759044900OtherCSNI - DEPT OF LABOR
FL1033840806OtherASCENSION HEALTH
FL1033840806OtherCIGNA