Provider Demographics
NPI:1003562257
Name:ANNE MARIE APRN LLC
Entity type:Organization
Organization Name:ANNE MARIE APRN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JETTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, AGPC-C
Authorized Official - Phone:941-266-1922
Mailing Address - Street 1:2253 GOLDENROD ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5318
Mailing Address - Country:US
Mailing Address - Phone:941-266-1922
Mailing Address - Fax:
Practice Address - Street 1:2253 GOLDENROD ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5318
Practice Address - Country:US
Practice Address - Phone:941-266-1922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care