=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750191706
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA NAVARRETE FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2025
-----------------------------------------------------
Last Update Date | 01/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2402 W PIERCE ST STE 6A
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88220-3566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-689-8700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 CHUCKWAGON RD
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88220-8750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-302-9258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 82308
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------