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General NPI Number Information
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NPI Number | 1962322453
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Entity Type | Individual
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Provider Name | ANNA DEREVYANKO
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Gender | Female
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Dates
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Enumeration Date | 07/16/2026
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Last Update Date | 07/16/2026
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Provider Practice Location Address
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Address Line | 3365 BURNS RD STE 101
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4302
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Country | US
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Telephone | 561-775-1061
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Fax | 561-775-1064
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Provider Business Mailing Address
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Address Line | 64 SHEFFIELD C
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City | WEST PALM BEACH
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State | FL
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Zip | 33417-1565
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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 | 11049081
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License Number State | FL
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