Provider Demographics
NPI:1801625066
Name:FELICIANO, ANNA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 EDGEWATER DR # 352
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6350
Mailing Address - Country:US
Mailing Address - Phone:407-504-2541
Mailing Address - Fax:
Practice Address - Street 1:5753 HIGHWAY 85 N STE 7937
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-9365
Practice Address - Country:US
Practice Address - Phone:270-439-8304
Practice Address - Fax:386-217-6025
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9423648363LP0808X
FLAPRN11034295363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health