Provider Demographics
NPI:1407097819
Name:ANDERSON, NINA FAY (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:FAY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 GREENHILL AVE
Mailing Address - Street 2:STE B
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-1800
Mailing Address - Country:US
Mailing Address - Phone:302-762-0200
Mailing Address - Fax:302-762-0500
Practice Address - Street 1:4011 N, MARKET STREET
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2329
Practice Address - Country:US
Practice Address - Phone:302-762-0200
Practice Address - Fax:302-762-0500
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELJ-0000230363LF0000X
PASP007751363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics