Healthcare Provider Details

I. General information

NPI: 1205207420
Provider Name (Legal Business Name): ANA GREENBERGER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 401
SAINT AUGUSTINE FL
32080
US

IV. Provider business mailing address

PO BOX 3123
SAINT AUGUSTINE FL
32085-3123
US

V. Phone/Fax

Practice location:
  • Phone: 904-461-6060
  • Fax: 904-461-6622
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9341774
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: