Provider Demographics
NPI:1063086841
Name:ANIL, ASHA (RN)
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:ANIL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ASHAMOL
Other - Middle Name:PAINAMATTOM
Other - Last Name:PAVITHRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9345 COVE POINT CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-2767
Mailing Address - Country:US
Mailing Address - Phone:561-809-7161
Mailing Address - Fax:
Practice Address - Street 1:9345 COVE POINT CIR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-2767
Practice Address - Country:US
Practice Address - Phone:561-809-7161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9260768163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse