Provider Demographics
NPI:1336214600
Name:PETERSEN, ANNE M (PA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:M
Other - Last Name:SZALANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:6555 CHESTER AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2279
Mailing Address - Country:US
Mailing Address - Phone:904-265-8209
Mailing Address - Fax:904-503-3577
Practice Address - Street 1:6555 CHESTER AVE STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2279
Practice Address - Country:US
Practice Address - Phone:904-265-8209
Practice Address - Fax:904-503-3577
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA2806OtherPA LICENSE
P00351506OtherRAILROAD MEDICARE
FLPA2806OtherPA LICENSE