Provider Demographics
NPI:1053415703
Name:GIFFORD, ANNA S (ARNP)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:S
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SYCAMORE CT S
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-4535
Mailing Address - Country:US
Mailing Address - Phone:352-382-1066
Mailing Address - Fax:352-382-1066
Practice Address - Street 1:13 SYCAMORE CT S
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-4535
Practice Address - Country:US
Practice Address - Phone:352-382-1066
Practice Address - Fax:352-382-1066
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLARNP2962952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9477YMedicare ID - Type Unspecified