Provider Demographics
NPI:1821012055
Name:FEDERICO, ANNA (FNP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:FEDERICO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 LAKESIDE RD
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:NJ
Mailing Address - Zip Code:07421-2905
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:
Practice Address - Street 1:156 NEWARK POMPTON TPKE
Practice Address - Street 2:MINUTECLINIC INSIDE CVS
Practice Address - City:PEQUANNOCK
Practice Address - State:NJ
Practice Address - Zip Code:07440-1327
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN07559800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPTAN028714XVAMedicare UPIN
NJ028714MBQMedicare UPIN