Provider Demographics
NPI:1043824071
Name:ALLIE, ANEESA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANEESA
Middle Name:
Last Name:ALLIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 N DILLARD ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2817
Mailing Address - Country:US
Mailing Address - Phone:407-877-8080
Mailing Address - Fax:407-877-0907
Practice Address - Street 1:436 N DILLARD ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2817
Practice Address - Country:US
Practice Address - Phone:407-877-8080
Practice Address - Fax:407-877-0907
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
FLPA9113560363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant