Provider Demographics
NPI:1154061380
Name:KANDARAPPALLIL, ANITTA
Entity Type:Individual
Prefix:
First Name:ANITTA
Middle Name:
Last Name:KANDARAPPALLIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 MOSSY TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7950
Mailing Address - Country:US
Mailing Address - Phone:813-716-0406
Mailing Address - Fax:
Practice Address - Street 1:2824 MOSSY TIMBER TRL
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-7950
Practice Address - Country:US
Practice Address - Phone:813-716-0406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11018687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily