Provider Demographics
NPI:1275618464
Name:PAGE, PHYLLIS ANN (PHD, ARNP)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:ANN
Last Name:PAGE
Suffix:
Gender:F
Credentials:PHD, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12313 CREEK EDGE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-6507
Mailing Address - Country:US
Mailing Address - Phone:813-661-9335
Mailing Address - Fax:
Practice Address - Street 1:12313 CREEK EDGE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-6507
Practice Address - Country:US
Practice Address - Phone:813-661-9335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2868992363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics