Provider Demographics
NPI:1023824059
Name:BELFORT, ANNISSA IRENE (APRN)
Entity type:Individual
Prefix:MS
First Name:ANNISSA
Middle Name:IRENE
Last Name:BELFORT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 NE 191ST ST APT 421
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4248
Mailing Address - Country:US
Mailing Address - Phone:954-540-8825
Mailing Address - Fax:
Practice Address - Street 1:1750 NE 191ST ST APT 421
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-4248
Practice Address - Country:US
Practice Address - Phone:954-540-8825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11036622363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health