Provider Demographics
NPI:1710197074
Name:SPIVEY, ANITA R (APRN)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:R
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:BUSHNELL
Mailing Address - State:FL
Mailing Address - Zip Code:33513-5603
Mailing Address - Country:US
Mailing Address - Phone:813-505-5674
Mailing Address - Fax:
Practice Address - Street 1:415 E NOBLE AVE
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-5603
Practice Address - Country:US
Practice Address - Phone:352-569-3102
Practice Address - Fax:352-793-6067
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2024-11-14
Deactivation Date:2024-11-05
Deactivation Code:
Reactivation Date:2024-11-14
Provider Licenses
StateLicense IDTaxonomies
FLRN9210547163WC0200X
FLAPRN11036237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine