Healthcare Provider Details

I. General information

NPI: 1205842028
Provider Name (Legal Business Name): ANNE MCCONAUGHEY MALTESE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE C. MCCONAUGHEY ARNP

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10,000 BAY PINES BOULEVARD
BAY PINES FL
33744
US

IV. Provider business mailing address

7768 62ND AVE N
ST PETERSBURG FL
33709-1202
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-6661
  • Fax: 727-398-9549
Mailing address:
  • Phone: 727-804-5593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number797982
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: