Provider Demographics
NPI:1205320587
Name:CLIFFORD, ANNA MARY (PNP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARY
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARY
Other - Last Name:TESILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQARE
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:NY
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:3344 CHAMBERS RD STE 100
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-1403
Practice Address - Country:US
Practice Address - Phone:607-742-2264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382862363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics