Provider Demographics
NPI:1073882510
Name:DOUGLAS, ANNA MARIA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ANNA MARIA
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:FNP-C
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 1403
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-1403
Mailing Address - Country:US
Mailing Address - Phone:719-301-9511
Mailing Address - Fax:719-888-1760
Practice Address - Street 1:731 IRONWOOD FLATS CIR
Practice Address - Street 2:#108
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:719-301-9511
Practice Address - Fax:719-888-1760
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21744363LF0000X
COAPN.0990332-NP363LF0000X
FLAPRN11016580363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO65720091Medicaid
CO446157YPPWMedicare PIN