Provider Demographics
NPI:1073399085
Name:MOUSSE, ANNA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MOUSSE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 TAMALPAIS DR STE 403
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1739
Mailing Address - Country:US
Mailing Address - Phone:415-924-2055
Mailing Address - Fax:
Practice Address - Street 1:770 TAMALPAIS DR STE 403
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1739
Practice Address - Country:US
Practice Address - Phone:415-924-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily