Provider Demographics
NPI:1306871777
Name:ANZALONE, PHILIP (ARNP)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:ANZALONE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 TAMIAMI TRL N
Mailing Address - Street 2:STE 2
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6203
Mailing Address - Country:US
Mailing Address - Phone:239-434-0009
Mailing Address - Fax:
Practice Address - Street 1:150 TAMIAMI TRL N
Practice Address - Street 2:STE 2
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6203
Practice Address - Country:US
Practice Address - Phone:239-434-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1004912363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY1242OtherBLUE SHIELD
FL40916OOtherBLUE CROSS
FLY1242OtherBLUE SHIELD