Provider Demographics
NPI:1043673593
Name:DE NARDO, ANAMARIA (CRNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANAMARIA
Middle Name:
Last Name:DE NARDO
Suffix:
Gender:F
Credentials:CRNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 SOUTH ST
Mailing Address - Street 2:APT 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1434
Mailing Address - Country:US
Mailing Address - Phone:732-309-6106
Mailing Address - Fax:
Practice Address - Street 1:4700 WISSAHICKON AVE STE 118
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-4248
Practice Address - Country:US
Practice Address - Phone:215-843-9720
Practice Address - Fax:267-597-3622
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA47-2491709OtherEMPLOYER IDENTIFICATION NUMBER