Provider Demographics
NPI:1619505773
Name:GROSS, ANTHONY PHILIP (AGACNP-BC, CNP, RN)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:PHILIP
Last Name:GROSS
Suffix:
Gender:M
Credentials:AGACNP-BC, CNP, RN
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Mailing Address - Street 1:17 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-4410
Mailing Address - Country:US
Mailing Address - Phone:617-466-9841
Mailing Address - Fax:844-810-9969
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:857-364-6020
Practice Address - Fax:844-810-9969
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2023-05-31
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Provider Licenses
StateLicense IDTaxonomies
MARN2307165163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse