Provider Demographics
NPI:1669559563
Name:BERESSI, ANNE H (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:H
Last Name:BERESSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10140 CENTURION PKWY N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0532
Mailing Address - Country:US
Mailing Address - Phone:904-697-4127
Mailing Address - Fax:904-697-5102
Practice Address - Street 1:1270 N WICKHAM RD STE 50
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8939
Practice Address - Country:US
Practice Address - Phone:321-421-7588
Practice Address - Fax:321-421-7590
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME015919208000000X
FLME100384208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME265790000Medicaid
FL022383300Medicaid