Healthcare Provider Details

I. General information

NPI: 1740572999
Provider Name (Legal Business Name): ANNA FERMIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 W HORIZON RIDGE PKWY
HENDERSON NV
89052-2729
US

IV. Provider business mailing address

DUMC 2905 0395 ORANGE ZONE DUKE CLINICS
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 702-247-9994
  • Fax: 702-651-9995
Mailing address:
  • Phone: 786-376-7560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number16977
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number16977
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number16977
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: