Provider Demographics
NPI:1831647411
Name:POLLAK, ANNA WINSHIP (FNP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:WINSHIP
Last Name:POLLAK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:WINSHIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2836 AUGUSTA RD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-3323
Mailing Address - Country:US
Mailing Address - Phone:039-390-5458
Mailing Address - Fax:
Practice Address - Street 1:2836 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-3323
Practice Address - Country:US
Practice Address - Phone:803-939-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1025887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1831647411Medicaid