Provider Demographics
NPI:1215395439
Name:ANTHONY, THRESIAMMA S (RN, MSN-FNP-C)
Entity Type:Individual
Prefix:
First Name:THRESIAMMA
Middle Name:S
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:RN, MSN-FNP-C
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Mailing Address - Street 1:1090 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-3700
Mailing Address - Country:US
Mailing Address - Phone:928-583-1000
Mailing Address - Fax:866-751-4157
Practice Address - Street 1:3212 N WINDSONG DR STE 200
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2255
Practice Address - Country:US
Practice Address - Phone:928-583-1000
Practice Address - Fax:866-751-4157
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP8386363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily