Provider Demographics
NPI:1164854030
Name:WHITE, ANNE LUCILLE (TCM)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:LUCILLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1557 SUGARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-6301
Mailing Address - Country:US
Mailing Address - Phone:407-310-2962
Mailing Address - Fax:
Practice Address - Street 1:1557 SUGARWOOD CIR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-6301
Practice Address - Country:US
Practice Address - Phone:407-310-2962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty