Provider Demographics
NPI:1205842028
Name:MALTESE, ANNE MCCONAUGHEY (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:MCCONAUGHEY
Last Name:MALTESE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:ANNE
Other - Middle Name:C
Other - Last Name:MCCONAUGHEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:7768 62ND AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-1202
Mailing Address - Country:US
Mailing Address - Phone:727-804-5593
Mailing Address - Fax:
Practice Address - Street 1:10,000 BAY PINES BOULEVARD
Practice Address - Street 2:
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:727-398-9549
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL797982363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health