Provider Demographics
NPI:1073037354
Name:PENA, PAMELA (NP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-2410
Mailing Address - Fax:956-362-2414
Practice Address - Street 1:1100 E DOVE AVE STE 202
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4681
Practice Address - Country:US
Practice Address - Phone:956-362-2410
Practice Address - Fax:956-362-2414
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133977363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP133977OtherLICENSE