Provider Demographics
NPI:1235838152
Name:ANTHONY, JUSTINA THERESA
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:THERESA
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 FRONT ST FL 1
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-1503
Mailing Address - Country:US
Mailing Address - Phone:215-292-8346
Mailing Address - Fax:
Practice Address - Street 1:1671 CROOKED OAK DR FL 1
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4269
Practice Address - Country:US
Practice Address - Phone:717-569-5331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027028363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care