Healthcare Provider Details

I. General information

NPI: 1720882582
Provider Name (Legal Business Name): DEBRA ANN ANDERSON PHD, FNP-C, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA ANN ANDERSON PHD

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 STONE BLVD
WEST SACRAMENTO CA
95691-4044
US

IV. Provider business mailing address

PO BOX 255433
SACRAMENTO CA
95865-5433
US

V. Phone/Fax

Practice location:
  • Phone: 916-371-4939
  • Fax:
Mailing address:
  • Phone: 703-786-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: