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 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:2305 VIDINA DR STE 102
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8066
Practice Address - Country:US
Practice Address - Phone:321-441-8332
Practice Address - Fax:321-319-4931
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9415945363LF0000X
GARN180536363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily