Healthcare Provider Details

I. General information

NPI: 1821651985
Provider Name (Legal Business Name): ALICIA IVANA BAENA MSN, RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13656 BRETON RIDGE ST # AH
HOUSTON TX
77070-6081
US

IV. Provider business mailing address

850 W RIO SALADO PKWY STE 201
TEMPE AZ
85281-3812
US

V. Phone/Fax

Practice location:
  • Phone: 281-429-8780
  • Fax: 281-763-7930
Mailing address:
  • Phone: 602-926-0849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP139889
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: