Anne Wister
Individual provider Active NPI Specialist · Melrose, FL
NPI 1194104414 · NPPES record last updated May 19, 2015
Key facts
- NPI
- 1194104414
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- MA43454 (FL)
- Practice address
- 102 Serenity Dr
Melrose, FL 32666-3032 - Phone
- (727) 251-2324
- NPI assigned
- May 19, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA43454 | FL | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA43454 | FL | Yes |
Addresses
Primary practice location
102 Serenity Dr
Melrose, FL 32666-3032
Mailing address
102 Serenity Dr
Melrose, FL 32666-3032
Phone (727) 251-2324
Other providers in Melrose, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.