Provider Demographics
NPI:1942745278
Name:CHANNER, ANNETTE MARJORIE (ARNP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MARJORIE
Last Name:CHANNER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 PEPIN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6919
Mailing Address - Country:US
Mailing Address - Phone:407-334-7305
Mailing Address - Fax:
Practice Address - Street 1:436 PEPIN DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-6919
Practice Address - Country:US
Practice Address - Phone:407-334-7305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9197752363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology