Healthcare Provider Details

I. General information

NPI: 1073882510
Provider Name (Legal Business Name): ANNA MARIA DOUGLAS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 475 BOX 1
FPO AP
96350-1200
US

IV. Provider business mailing address

13800 EGRETS NEST DR APT 1933
JACKSONVILLE FL
32258-4250
US

V. Phone/Fax

Practice location:
  • Phone: 315-255-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21744
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11016580
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0990332-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: