Provider Demographics
NPI:1861208456
Name:POOLE, ANASTASIA D
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:D
Last Name:POOLE
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 1:13395 CHESAPEAKE PL
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-2096
Mailing Address - Country:US
Mailing Address - Phone:330-280-6642
Mailing Address - Fax:
Practice Address - Street 1:13395 CHESAPEAKE PL
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-2096
Practice Address - Country:US
Practice Address - Phone:330-280-6642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP400004948500374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide