Provider Demographics
NPI:1568657476
Name:BYRD, ANITA CECILIA (CNM)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:CECILIA
Last Name:BYRD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8075 GATE PKWY W
Mailing Address - Street 2:#305
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3684
Mailing Address - Country:US
Mailing Address - Phone:904-296-2992
Mailing Address - Fax:904-296-2993
Practice Address - Street 1:8075 GATE PKWY W
Practice Address - Street 2:#305
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-3684
Practice Address - Country:US
Practice Address - Phone:904-296-2992
Practice Address - Fax:904-296-2993
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2663842367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife