Provider Demographics
NPI:1740469691
Name:HERBERT, ANASTASIA J (FNP)
Entity type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:J
Last Name:HERBERT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:ANASTASIA
Other - Middle Name:JOANNE
Other - Last Name:MASINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN, MSN, FNP
Mailing Address - Street 1:260 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4922
Mailing Address - Country:US
Mailing Address - Phone:919-488-0015
Mailing Address - Fax:919-277-0066
Practice Address - Street 1:1005 BIG OAK CT
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6565
Practice Address - Country:US
Practice Address - Phone:919-266-5669
Practice Address - Fax:919-488-1717
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC183266363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004597Medicaid