Provider Demographics
NPI:1992285605
Name:ANDERSON, MICHAEL I (FNP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:ANDERSON
Suffix:I
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12700 PARK CENTRAL DR STE 1210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-1522
Mailing Address - Country:US
Mailing Address - Phone:702-360-2763
Mailing Address - Fax:
Practice Address - Street 1:2650 N TENAYA WAY STE 208
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1104
Practice Address - Country:US
Practice Address - Phone:702-360-2100
Practice Address - Fax:702-360-3201
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA843338363LF0000X
TX1118851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily