Provider Demographics
NPI:1447792825
Name:KURIAN, ANITA ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:ELIZABETH
Last Name:KURIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5690 ATLANTIC AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8217
Mailing Address - Country:US
Mailing Address - Phone:201-336-4754
Mailing Address - Fax:
Practice Address - Street 1:20665 LYONS RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3911
Practice Address - Country:US
Practice Address - Phone:561-883-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00414900363A00000X
NY020311-1363A00000X
FL9113252363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant