Provider Demographics
NPI:1700772092
Name:ANNEAUD, DEANNA
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:ANNEAUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9719 MULBERRY MARSH LN
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-0227
Mailing Address - Country:US
Mailing Address - Phone:813-263-2357
Mailing Address - Fax:
Practice Address - Street 1:9719 MULBERRY MARSH LN
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-0227
Practice Address - Country:US
Practice Address - Phone:813-263-2357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9494845163W00000X
FL1103722363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse