Provider Demographics
NPI:1629814546
Name:ANTHONY, AMBREA (NP)
Entity type:Individual
Prefix:MRS
First Name:AMBREA
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:AMBREA
Other - Middle Name:
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1322 OAK ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36108-3527
Mailing Address - Country:US
Mailing Address - Phone:334-215-0702
Mailing Address - Fax:
Practice Address - Street 1:200 WALLACE DR
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:AL
Practice Address - Zip Code:36017-2613
Practice Address - Country:US
Practice Address - Phone:334-544-7322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-122113363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily