Healthcare Provider Details

I. General information

NPI: 1316485394
Provider Name (Legal Business Name): ANITA SUZETTE COMBS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PATEWOOD DR SUITE B350
GREENVILLE SC
29615-3593
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-4500
  • Fax:
Mailing address:
  • Phone: 864-522-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number20724
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20724
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: