Healthcare Provider Details

I. General information

NPI: 1356701155
Provider Name (Legal Business Name): MRS. ANNA PIRGOUSIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA RICHARDSON

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 KINGSLEY AVE 105
ORANGE PARK FL
32073-4490
US

IV. Provider business mailing address

4500 SAN PABLO RD S
JACKSONVILLE FL
32224-1865
US

V. Phone/Fax

Practice location:
  • Phone: 904-215-7015
  • Fax:
Mailing address:
  • Phone: 904-953-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9319771
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: