Provider Demographics
NPI:1174672562
Name:PURDY, ANNE MARIE (APRN)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:MARIE
Last Name:PURDY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:5821 KRISTINA PL
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-5066
Mailing Address - Country:US
Mailing Address - Phone:813-390-0162
Mailing Address - Fax:813-269-4669
Practice Address - Street 1:5821 KRISTINA PL
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-5066
Practice Address - Country:US
Practice Address - Phone:813-390-0162
Practice Address - Fax:813-269-4669
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1265232363LA2200X
CA95018464363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health