MEDICARE: TAKELA NAQUAY ANDERSON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	5004483	NC

General Provider Information

NPI Number	:	1023342144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAKELA NAQUAY ANDERSON FNP

Provider Business Mailing Address
First Line	:	8108 BROAD RIDGE CT
Second Line	:
City	:	BROWNS SUMMIT
State	:	NC
Zip	:	27214-9848
Country	:	US
Telephone Number	:	336-253-4365
Fax Number	:

Provider Business Practice Location Address
First Line	:	4002 SPRING GARDEN ST
Second Line	:	STE C
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1683
Country	:	US
Telephone Number	:	336-553-0793
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2009
Last Update Date	:	08/20/2020

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