MEDICARE: MRS. DENISHA DEANNA RENEE ANDERSON FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	11044048	FL

General Provider Information

NPI Number	:	1215890462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISHA DEANNA RENEE ANDERSON FNP-BC

Provider Business Mailing Address
First Line	:	19321 EAGLE CREEK LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3852
Country	:	US
Telephone Number	:	210-875-8601
Fax Number	:	210-875-8601

Provider Business Practice Location Address
First Line	:	19321 EAGLE CREEK LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3852
Country	:	US
Telephone Number	:	210-875-8601
Fax Number	:	210-875-8601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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