MEDICARE: ANNE SEXTON

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	363A00000X	Physician Assistant	PA9108242	FL
2	207N00000X	Dermatology Physician	PA4710	SC

General Provider Information

NPI Number	:	1578954145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE SEXTON

Provider Business Mailing Address
First Line	:	151 SOUTHHALL LN
Second Line	:	STE 300
City	:	MAITLAND
State	:	FL
Zip	:	32751-7176
Country	:	US
Telephone Number	:	407-875-2080
Fax Number	:	407-650-3455

Provider Business Practice Location Address
First Line	:	908 SMITHFIELD WAY STE 101
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-6956
Country	:	US
Telephone Number	:	803-220-2782
Fax Number	:	803-233-2968

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

Provider Enumeration Date	:	02/18/2015
Last Update Date	:	10/17/2023

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Directions to “ ANNE SEXTON ” Practice Location

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