Provider Demographics
NPI:1013476977
Name:OUAFFAI, ANAS
Entity Type:Individual
Prefix:
First Name:ANAS
Middle Name:
Last Name:OUAFFAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7657 CARLTON ARMS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-4810
Mailing Address - Country:US
Mailing Address - Phone:407-820-6536
Mailing Address - Fax:
Practice Address - Street 1:35902 US-27
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-3384
Practice Address - Country:US
Practice Address - Phone:863-421-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29060225200000X
CA52753225200000X
MA10083-AH-PA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant