Provider Demographics
NPI:1174952469
Name:THREATTE, ANN LOUISE (DO)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:LOUISE
Last Name:THREATTE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:THREATTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1839 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713
Mailing Address - Country:US
Mailing Address - Phone:727-322-1054
Mailing Address - Fax:727-322-2725
Practice Address - Street 1:1839 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8900
Practice Address - Country:US
Practice Address - Phone:727-322-1054
Practice Address - Fax:727-322-2725
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13704207R00000X
FLUO3705207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH0JX6OtherBLUE CROSS
FL112765400Medicaid