Basic Information
| Provider Information | |||||||||
| NPI: | 1386045540 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUINTERO | ||||||||
| FirstName: | ANA LISA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSN, APRN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1229 S VETERANS BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785893232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9567875454 | ||||||||
| FaxNumber: | 9567875486 | ||||||||
| Practice Location | |||||||||
| Address1: | 1229 S VETERANS BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785893232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9567875454 | ||||||||
| FaxNumber: | 9567875486 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2014 | ||||||||
| LastUpdateDate: | 04/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP126194 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 341017701 | 05 | TX | MEDICAID |