Provider Demographics
NPI:1952765810
Name:WEIR, ANNA WAGNER (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:WAGNER
Last Name:WEIR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:LEE
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1951 CLAIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3415
Mailing Address - Country:US
Mailing Address - Phone:941-755-2456
Mailing Address - Fax:941-753-3083
Practice Address - Street 1:712 53RD AVE E STE C
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-5827
Practice Address - Country:US
Practice Address - Phone:941-755-2456
Practice Address - Fax:941-753-3083
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN180536363LF0000X
FLARNP9415945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily