| Doctor Name: | ANNA LISA GANTZ |
| NPI Number: | 1407864275 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | 71000770A |
| Business Practice Address: | 6300 46th Ave N Kenneth City, FL - 337093104 |
| Business Phone Number: | 7275441444 |
| Business Fax Number: | |
| Mailing Address: | 3980 64th St N, ST PETERSBURG |
| State: | FL |
| Postal Code: | 337094825 |
| Phone Number: | 3177095122 |
| Fax Number: | |
| NPI Enumeration Date: | 08/04/2006 |
| NPI Last Update Date: | 12/01/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 71000770A |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |