Provider Demographics
NPI:1457897282
Name:GROWNEY, ANNE MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:GROWNEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIA
Other - Last Name:WEINHOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3280 HENDERSON DR STE C
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5290
Mailing Address - Country:US
Mailing Address - Phone:910-914-8450
Mailing Address - Fax:888-745-7026
Practice Address - Street 1:3280 HENDERSON DR STE C
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5290
Practice Address - Country:US
Practice Address - Phone:910-915-8450
Practice Address - Fax:888-745-7026
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005610363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant