Healthcare Provider Details

I. General information

NPI: 1790949113
Provider Name (Legal Business Name): CAMILLE NANCY ANISE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8592 POTTER PARK DR
SARASOTA FL
34238-5467
US

IV. Provider business mailing address

8592 POTTER PARK DR
SARASOTA FL
34238-5467
US

V. Phone/Fax

Practice location:
  • Phone: 941-921-6618
  • Fax: 941-922-0556
Mailing address:
  • Phone: 941-921-6618
  • Fax: 941-922-0556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME110552
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: