Provider Demographics
NPI:1053003012
Name:GRAVES, ANTHONY FREEMAN (FNP-C)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:FREEMAN
Last Name:GRAVES
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6136 170TH ST APT M4
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1957
Mailing Address - Country:US
Mailing Address - Phone:718-709-0940
Mailing Address - Fax:516-441-6768
Practice Address - Street 1:6212 WALNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3706
Practice Address - Country:US
Practice Address - Phone:215-476-6264
Practice Address - Fax:215-689-0893
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP027579207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine