Provider Demographics
NPI:1942734512
Name:GOULD, ANITA E (FNP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:E
Last Name:GOULD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14317 POTRANCO RD STE 205228
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-7125
Mailing Address - Country:US
Mailing Address - Phone:210-900-5495
Mailing Address - Fax:
Practice Address - Street 1:13750 SAN PEDRO AVE STE 140
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4358
Practice Address - Country:US
Practice Address - Phone:210-900-5495
Practice Address - Fax:949-399-6008
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX672611163W00000X
GA154014163W00000X, 363LF0000X
VA0024174839363LF0000X
TXAP135557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse