Provider Demographics
NPI:1922001866
Name:JONES, ANITA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:JONES
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 1:21097 NE 27TH CT
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1204
Mailing Address - Country:US
Mailing Address - Phone:305-749-0480
Mailing Address - Fax:305-749-0481
Practice Address - Street 1:21097 NE 27TH CT
Practice Address - Street 2:SUITE 400
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1204
Practice Address - Country:US
Practice Address - Phone:305-749-0480
Practice Address - Fax:305-749-0481
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75272174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25450004000Medicaid
FLG65876Medicare UPIN
FL25450004000Medicaid