Individual
MISS TINA MICHELLE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1 SHIRCLIFF WAY, JACKSONVILLE, FL 32204-4748
(904) 308-7300
Mailing address
3 SHIRCLIFF WAY, STE 625, JACKSONVILLE, FL 32204-4776
(904) 305-6156
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
11016072
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15424361
CAQH
FL
Enumeration date
10/28/2021
Last updated
02/03/2022
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