Provider Demographics
NPI:1891040135
Name:GLEASON, ANNE BRIDGET (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:BRIDGET
Last Name:GLEASON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 EAST 223RD ST
Mailing Address - Street 2:SOUTH BAY FAMILY HEALTH CARE
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745
Mailing Address - Country:US
Mailing Address - Phone:310-549-7259
Mailing Address - Fax:
Practice Address - Street 1:270 EAST 223RD ST
Practice Address - Street 2:SOUTH BAY FAMILY HEALTH CARE
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745
Practice Address - Country:US
Practice Address - Phone:310-549-7259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2274503363LF0000X
CA22900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily