Healthcare Provider Details

I. General information

NPI: 1477374973
Provider Name (Legal Business Name): ANA CECILIA SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 W SUNSET AVE
SPRINGDALE AR
72762-4950
US

IV. Provider business mailing address

2861 WYANDOTTE AVE
SPRINGDALE AR
72764-3009
US

V. Phone/Fax

Practice location:
  • Phone: 479-717-7089
  • Fax:
Mailing address:
  • Phone: 818-396-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number221495
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: