Provider Demographics
NPI:1770395147
Name:ANASTASIA PSYCHIATRY PA
Entity type:Organization
Organization Name:ANASTASIA PSYCHIATRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALIN
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-732-1133
Mailing Address - Street 1:1812 HARBOR LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-4274
Mailing Address - Country:US
Mailing Address - Phone:239-494-0040
Mailing Address - Fax:
Practice Address - Street 1:1812 HARBOR LN
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-4274
Practice Address - Country:US
Practice Address - Phone:239-494-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-23
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty