Provider Demographics
NPI:1093232761
Name:JENSEN, ANNA JOHNSTON
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:JOHNSTON
Last Name:JENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ANNA
Other - Middle Name:EVANS
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:314 W SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1959
Mailing Address - Country:US
Mailing Address - Phone:704-607-2134
Mailing Address - Fax:
Practice Address - Street 1:111 2ND AVE NE STE 900
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3434
Practice Address - Country:US
Practice Address - Phone:813-690-1327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist