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General NPI Number Information
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NPI Number | 1326545047
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Entity Type | Individual
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Provider Name | ANITTA JANOSH PURACKAL ARNP
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Gender | Female
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 3427 BROOK CROSSING DR
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City | BRANDON
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State | FL
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Zip | 33511
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Country | US
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Telephone | 813-654-5331
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Fax |
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Provider Business Mailing Address
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Address Line | 12017 GRAND KEMPSTON DR
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City | GIBSONTON
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State | FL
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Zip | 33534-5367
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9344834
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License Number State | FL
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