Provider Demographics
NPI:1457841793
Name:JIVOTOVSKI, ANNA LEA (FNP)
Entity Type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:LEA
Last Name:JIVOTOVSKI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 S MICHIGAN AVE APT 1108
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3634
Mailing Address - Country:US
Mailing Address - Phone:703-309-9881
Mailing Address - Fax:
Practice Address - Street 1:1965 RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3312
Practice Address - Country:US
Practice Address - Phone:716-608-0041
Practice Address - Fax:716-608-0042
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily