Provider Demographics
NPI:1780132886
Name:ANTONY, ANU ROSE
Entity type:Individual
Prefix:
First Name:ANU
Middle Name:ROSE
Last Name:ANTONY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 HERITAGE WELL LN
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1262
Mailing Address - Country:US
Mailing Address - Phone:484-477-6545
Mailing Address - Fax:
Practice Address - Street 1:4502 HERITAGE WELL LN
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1262
Practice Address - Country:US
Practice Address - Phone:484-477-6545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-17
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131523363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily