Provider Demographics
NPI:1740759984
Name:ROBERTS, ANNE HOLLINGSWORTH (APRN)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:HOLLINGSWORTH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 782
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-0782
Mailing Address - Country:US
Mailing Address - Phone:847-951-4419
Mailing Address - Fax:
Practice Address - Street 1:10011 S CENTENNIAL PKWY STE 350
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4137
Practice Address - Country:US
Practice Address - Phone:801-566-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10162617-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily