Provider Demographics
NPI:1073762365
Name:FLOREZ, ANNA (FNP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:FLOREZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W COUNTRY CLUB RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5839
Mailing Address - Country:US
Mailing Address - Phone:575-625-3400
Mailing Address - Fax:
Practice Address - Street 1:311 W COUNTRY CLUB RD STE 1
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5839
Practice Address - Country:US
Practice Address - Phone:575-625-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR31988364SA2200X
NMCNP01692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCNP-01692OtherNM LICENSE