MEDICARE: RITA AVA ANNMARIE ANDERSON NP

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	163WP0807X	Child & Adolescent Psychiatric/Mental Health Registered Nurse	2025084485	FL

General Provider Information

NPI Number	:	1487514014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITA AVA ANNMARIE ANDERSON NP

Provider Business Mailing Address
First Line	:	4241 SW JAME ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-6447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4241 SW JAME ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-6447
Country	:	US
Telephone Number	:	954-817-0944
Fax Number	:

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

Provider Enumeration Date	:	11/15/2025
Last Update Date	:	11/15/2025

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