Provider Demographics
NPI:1740530096
Name:GEORGE, ANISH (ARPN)
Entity type:Individual
Prefix:MR
First Name:ANISH
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:ARPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5728 MAJOR BLVD 528
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7962
Mailing Address - Country:US
Mailing Address - Phone:407-352-2542
Mailing Address - Fax:407-352-2547
Practice Address - Street 1:6149 CHANCELLOR DR STE 2780
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5633
Practice Address - Country:US
Practice Address - Phone:407-352-2542
Practice Address - Fax:407-352-2547
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9412725363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner