Provider Demographics
NPI:1316282668
Name:CROSSLAND, ANITA LOUISE (PA-C)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:LOUISE
Last Name:CROSSLAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1330 PARKWAY AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3006
Mailing Address - Country:US
Mailing Address - Phone:609-538-1212
Mailing Address - Fax:609-538-7571
Practice Address - Street 1:1330 PARKWAY AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3006
Practice Address - Country:US
Practice Address - Phone:609-538-1212
Practice Address - Fax:609-538-7571
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00059800363A00000X
PAMA002357L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant