Provider Demographics
NPI:1649764358
Name:MALLOY, ANNA ELIZABETH (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:ELIZABETH
Last Name:MALLOY
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 RIDGEWOOD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1286
Mailing Address - Country:US
Mailing Address - Phone:610-376-8691
Mailing Address - Fax:610-376-8745
Practice Address - Street 1:2240 RIDGEWOOD RD STE 100
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1286
Practice Address - Country:US
Practice Address - Phone:610-376-8691
Practice Address - Fax:610-376-8745
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9487280363LP0200X
PASP022972363L00000X
FL9487280363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
20180497OtherPCNB CERTIFICATION
FLARNP9487280OtherFL DEPT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE
PA1038679770001Medicaid
PASP022972OtherNP LICENSE PA