Provider Demographics
NPI:1215218292
Name:DEVINE, ANJANETTE MICHELLE (FNP)
Entity type:Individual
Prefix:MRS
First Name:ANJANETTE
Middle Name:MICHELLE
Last Name:DEVINE
Suffix:
Gender:
Credentials:FNP
Other - Prefix:MS
Other - First Name:ANJANETTE
Other - Middle Name:MICHELLE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 746085
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6085
Mailing Address - Country:US
Mailing Address - Phone:469-727-6675
Mailing Address - Fax:
Practice Address - Street 1:4541 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-5308
Practice Address - Country:US
Practice Address - Phone:601-533-7017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR874930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily