Healthcare Provider Details

I. General information

NPI: 1003506403
Provider Name (Legal Business Name): ANASTASIA SOPHIA TZOBANAKIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANASTASIA SOPHIA JENNINGS

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 05/09/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 FLYCATCHER RD
BROOKSVILLE FL
34613
US

IV. Provider business mailing address

10475 FLYCATCHER RD
BROOKSVILLE FL
34613
US

V. Phone/Fax

Practice location:
  • Phone: 352-263-1068
  • Fax:
Mailing address:
  • Phone: 352-263-1068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN9351457
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: