Provider Demographics
NPI:1699561282
Name:ROBERTSON, ANASTARSIA
Entity type:Individual
Prefix:
First Name:ANASTARSIA
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 AUSTIN PEAY HWY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-3802
Mailing Address - Country:US
Mailing Address - Phone:901-644-7549
Mailing Address - Fax:901-445-8073
Practice Address - Street 1:3320 AUSTIN PEAY HWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-3802
Practice Address - Country:US
Practice Address - Phone:901-644-7549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00645374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ091048Medicaid