Healthcare Provider Details

I. General information

NPI: 1962322453
Provider Name (Legal Business Name): ANNA DEREVYANKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3365 BURNS RD STE 101
PALM BEACH GARDENS FL
33410-4302
US

IV. Provider business mailing address

64 SHEFFIELD C
WEST PALM BEACH FL
33417-1565
US

V. Phone/Fax

Practice location:
  • Phone: 561-775-1061
  • Fax: 561-775-1064
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11049081
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: