Provider Demographics
NPI:1003353483
Name:BACIC, ANA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:BACIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21600 HIGHWAY 99
Mailing Address - Street 2:SUITE 260
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8012
Mailing Address - Country:US
Mailing Address - Phone:917-566-1120
Mailing Address - Fax:
Practice Address - Street 1:21600 HIGHWAY 99
Practice Address - Street 2:SUITE 260
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8012
Practice Address - Country:US
Practice Address - Phone:425-774-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60720095363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner