Provider Demographics
NPI:1760417265
Name:SPADACCINI, ANETA EVELYN (NP, APN)
Entity Type:Individual
Prefix:MRS
First Name:ANETA
Middle Name:EVELYN
Last Name:SPADACCINI
Suffix:
Gender:F
Credentials:NP, APN
Other - Prefix:MRS
Other - First Name:ANETA
Other - Middle Name:EVELYN
Other - Last Name:GRODZENSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP, APN
Mailing Address - Street 1:220 SW NATURA AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-3026
Mailing Address - Country:US
Mailing Address - Phone:954-360-7000
Mailing Address - Fax:954-360-7005
Practice Address - Street 1:220 SW NATURA AVE
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-3026
Practice Address - Country:US
Practice Address - Phone:954-360-7000
Practice Address - Fax:954-360-7005
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9405292363LA2200X, 363LA2200X, 363LA2200X
FLARNP9405292208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100023600Medicaid
FL1316078769OtherNPI
FL1316078769OtherNPI
ILQ53101Medicare UPIN
IL36-2772589OtherEIN