Healthcare Provider Details

I. General information

NPI: 1255945960
Provider Name (Legal Business Name): JESSICA MARIE ANAYA FNP-BC, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 W US HIGHWAY 50
PUEBLO CO
81008-1606
US

IV. Provider business mailing address

925 W US HIGHWAY 50
PUEBLO CO
81008-1606
US

V. Phone/Fax

Practice location:
  • Phone: 719-406-7376
  • Fax: 949-703-7023
Mailing address:
  • Phone: 719-406-7376
  • Fax: 949-703-7023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0995883-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0995883-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: