Provider Demographics
NPI:1508869330
Name:ALLEN, ANNA K (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:K
Last Name:ALLEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 LAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3211
Mailing Address - Country:US
Mailing Address - Phone:352-799-5411
Mailing Address - Fax:
Practice Address - Street 1:605 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3211
Practice Address - Country:US
Practice Address - Phone:352-799-5411
Practice Address - Fax:352-544-2713
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1735792363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305836100Medicaid
FLY046SOtherBC/BS FLA
FLP00179739OtherRAILROAD MEDICARE
FL305836100Medicaid
FLY046SOtherBC/BS FLA
Q01745Medicare UPIN
FLU1763XMedicare PIN