Provider Demographics
NPI:1043940687
Name:ANNAN, CLARISSA JORDAN (CRNP)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:JORDAN
Last Name:ANNAN
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 1:1239 LAVENDER LN
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-9565
Mailing Address - Country:US
Mailing Address - Phone:251-747-0980
Mailing Address - Fax:
Practice Address - Street 1:156 E 15TH AVE
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-3516
Practice Address - Country:US
Practice Address - Phone:251-948-4290
Practice Address - Fax:251-948-7682
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-164543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily