Provider Demographics
NPI:1972589281
Name:JANUS, ANN MARIE LOUISE (ARNP)
Entity type:Individual
Prefix:MS
First Name:ANN MARIE
Middle Name:LOUISE
Last Name:JANUS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1140
Mailing Address - Country:US
Mailing Address - Phone:954-525-2003
Mailing Address - Fax:954-525-0212
Practice Address - Street 1:420 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1140
Practice Address - Country:US
Practice Address - Phone:954-525-2003
Practice Address - Fax:954-525-0212
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1095032363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P18953Medicare UPIN
FLY3606Medicare ID - Type Unspecified