Healthcare Provider Details

I. General information

NPI: 1336194430
Provider Name (Legal Business Name): NSENGA RIBEIRO-ANDERSON APRN, FNP-BC, ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6422 BRIDGECREST DR
LITHIA FL
33547-4865
US

IV. Provider business mailing address

6422 BRIDGECREST DR
LITHIA FL
33547-4865
US

V. Phone/Fax

Practice location:
  • Phone: 314-363-6205
  • Fax:
Mailing address:
  • Phone: 314-363-6205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN144693
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9464400
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: