Provider Demographics
NPI:1205194594
Name:MOAK, ANNA M (APRN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:MOAK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:M
Other - Last Name:CRAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1920 2ND LOOP RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6123
Mailing Address - Country:US
Mailing Address - Phone:843-678-9777
Mailing Address - Fax:843-665-2814
Practice Address - Street 1:1920 2ND LOOP RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6123
Practice Address - Country:US
Practice Address - Phone:843-678-9777
Practice Address - Fax:843-665-2814
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17764163WP0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0000XNursing Service ProvidersRegistered NursePain Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC00646672Medicare PIN