Provider Demographics
NPI:1992771224
Name:DRAKE, ANITA L (RN,FNP)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:L
Last Name:DRAKE
Suffix:
Gender:F
Credentials:RN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 COLLEGE ST
Mailing Address - Street 2:STE 200
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4612
Mailing Address - Country:US
Mailing Address - Phone:409-813-1677
Mailing Address - Fax:409-232-0559
Practice Address - Street 1:1255 HIGHWAY 327 E
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-6007
Practice Address - Country:US
Practice Address - Phone:409-384-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP109650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX571660OtherRN LICENSE
TX571660OtherRN LICENSE