Provider Demographics
NPI:1760761589
Name:CISNEROS, ANNA MORENO (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MORENO
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 HWY 2297
Mailing Address - Street 2:LOT A
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-2930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1104 HWY 2297
Practice Address - Street 2:LOT A
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-2930
Practice Address - Country:US
Practice Address - Phone:850-215-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2806912363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner