Provider Demographics
NPI:1043228497
Name:ANDERSON, NANCY PHIPPS (CRNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:PHIPPS
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-229-5661
Mailing Address - Fax:850-229-5662
Practice Address - Street 1:3871 E HIGHWAY 98
Practice Address - Street 2:SUITE 203
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-5301
Practice Address - Country:US
Practice Address - Phone:850-229-5661
Practice Address - Fax:850-229-5662
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1075808363L00000X
FLARNP9341898363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner