Provider Demographics
NPI:1134143860
Name:ANDERSON, VERA O (ARNP)
Entity Type:Individual
Prefix:MS
First Name:VERA
Middle Name:O
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 W COLUMBIA ST
Mailing Address - Street 2:STE 201
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6100
Mailing Address - Country:US
Mailing Address - Phone:407-852-2760
Mailing Address - Fax:321-843-6729
Practice Address - Street 1:21 W COLUMBIA ST
Practice Address - Street 2:STE 201
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6100
Practice Address - Country:US
Practice Address - Phone:407-852-2760
Practice Address - Fax:321-843-6729
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2654152363L00000X
FL2654152363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004784300Medicaid
FLARNP2654152OtherMEDICAL LICENSE
FLARNP2654152OtherMEDICAL LICENSE