Provider Demographics
NPI:1780574418
Name:PENNYCOOKE, ANYA (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:ANYA
Middle Name:
Last Name:PENNYCOOKE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 NW 111TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7520
Mailing Address - Country:US
Mailing Address - Phone:754-367-0491
Mailing Address - Fax:
Practice Address - Street 1:3601 NW 111TH AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7520
Practice Address - Country:US
Practice Address - Phone:754-367-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2025028083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily