Provider Demographics
NPI:1669950739
Name:INTERRANTE, ANTHONY III (NP)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:INTERRANTE
Suffix:III
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 N 28TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7447
Mailing Address - Country:US
Mailing Address - Phone:215-872-9575
Mailing Address - Fax:404-585-2688
Practice Address - Street 1:3308 N 28TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7447
Practice Address - Country:US
Practice Address - Phone:215-872-9575
Practice Address - Fax:404-585-2688
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9094363LA2100X
VA0024175465363LA2200X
IL209024920363LA2200X
LA229596363LA2200X
DELP-0010452363LA2200X
NC5017761363LA2200X
OR202109086NP-PP363LA2200X
CA95007049363LA2200X
PASP024740363LA2200X
HIAPRN-3812363LA2200X
AZ262620363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care