Provider Demographics
NPI:1578512794
Name:ANDERSON, URSULA K (ARNP)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:K
Last Name:ANDERSON
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 1:200 E SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3142
Mailing Address - Country:US
Mailing Address - Phone:321-725-4500
Mailing Address - Fax:321-956-2540
Practice Address - Street 1:200 E SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3142
Practice Address - Country:US
Practice Address - Phone:321-725-4500
Practice Address - Fax:321-956-2540
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2722032363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP41841Medicare UPIN
FLY0151AMedicare PIN
FLY01501XMedicare PIN