Provider Demographics
NPI:1407306145
Name:PITTMAN, ANISHA (APN-C)
Entity Type:Individual
Prefix:
First Name:ANISHA
Middle Name:
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 VICTORIA CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-3202
Mailing Address - Country:US
Mailing Address - Phone:732-236-9941
Mailing Address - Fax:
Practice Address - Street 1:32 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1429
Practice Address - Country:US
Practice Address - Phone:732-462-4100
Practice Address - Fax:732-462-3798
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00666700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily