| Entity Name: | ANITA S. WESTAFER M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 05 Jan 1987 (38 years ago) |
| Document Number: | J50052 |
| FEI/EIN Number | 592749645 |
| Address: | 2569 GULF BREEZE PARKWAY, GULF BREEZE, FL, 32563 |
| Mail Address: | 2569 GULF BREEZE PARKWAY, GULF BREEZE, FL, 32563 |
| ZIP code: | 32563 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972565091 | 2006-04-04 | 2012-06-13 | 2569 GULF BREEZE PKWY, GULF BREEZE, FL, 325633043, US | 2569 GULF BREEZE PKWY, GULF BREEZE, FL, 325633043, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-934-0932 |
| Fax | 8509340737 |
Authorized person
| Name | DR. ANITA S WESTAFER |
| Role | PHYSICIAN/OWNER |
| Phone | 8509340932 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME36003 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDA MEDICAL LICENSE NUMBER |
| Number | ME36003 |
| State | FL |
| Issuer | MEDICAID |
| Number | 263385000 |
| State | FL |
| Issuer | BCBS FLORIDA GROUP # |
| Number | 34928 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WESTAFER, ANITA S. M.D. | Agent | 2569 GULF BREEZE PARKWAY, GULF BREEZE, FL, 32563 |
| Name | Role | Address |
|---|---|---|
| WESTAFER ANITA S | Director | 2569 GULF BREEZE PARKWAY, GULF BREEZE, FL, 32563 |
| Name | Role | Address |
|---|---|---|
| WESTAFER ANITA S | President | 2569 GULF BREEZE PARKWAY, GULF BREEZE, FL, 32563 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
