Provider Demographics
NPI:1689733909
Name:DERISO, ANNA T (RNC, WHNP)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:T
Last Name:DERISO
Suffix:
Gender:F
Credentials:RNC, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 PEACHTREE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2752
Mailing Address - Country:US
Mailing Address - Phone:404-869-3224
Mailing Address - Fax:
Practice Address - Street 1:77 COLLIER RD NW
Practice Address - Street 2:SUITE 2050
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1764
Practice Address - Country:US
Practice Address - Phone:404-351-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN146512 NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner