Provider Demographics
NPI:1609247089
Name:LIEBIG, ANNELI B (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ANNELI
Middle Name:B
Last Name:LIEBIG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1501 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7512
Mailing Address - Country:US
Mailing Address - Phone:954-788-0739
Mailing Address - Fax:954-788-7347
Practice Address - Street 1:1501 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-7512
Practice Address - Country:US
Practice Address - Phone:954-788-0739
Practice Address - Fax:954-788-7347
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2215212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1609247089Medicaid