Provider Demographics
NPI:1689363665
Name:PIETRO, ANNALISE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANNALISE
Middle Name:
Last Name:PIETRO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22078 SHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-3320
Mailing Address - Country:US
Mailing Address - Phone:518-705-5615
Mailing Address - Fax:
Practice Address - Street 1:2484 CARING WAY UNIT B
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5306
Practice Address - Country:US
Practice Address - Phone:800-771-7164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025856363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily