Provider Demographics
NPI:1770658957
Name:NIEVES, ANETTE (MD)
Entity Type:Individual
Prefix:
First Name:ANETTE
Middle Name:
Last Name:NIEVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 SE 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4623
Mailing Address - Country:US
Mailing Address - Phone:352-901-6210
Mailing Address - Fax:352-435-7148
Practice Address - Street 1:1724 SE 17TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4623
Practice Address - Country:US
Practice Address - Phone:352-901-6210
Practice Address - Fax:352-435-7148
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 987892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLG159OtherMEDICARE
FLME98789OtherSTATE LICENSE
FLAF843YMedicare PIN