Provider Demographics
NPI:1689811143
Name:ANDERSON, VIRGINIA FAYE (CRTT)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:FAYE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CRTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5808
Mailing Address - Country:US
Mailing Address - Phone:239-403-0400
Mailing Address - Fax:
Practice Address - Street 1:949 2ND AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5808
Practice Address - Country:US
Practice Address - Phone:239-403-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT5469174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist