Provider Demographics
NPI:1114469111
Name:SPADA, ANISSA ELLEN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ANISSA
Middle Name:ELLEN
Last Name:SPADA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 E 1ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4086
Mailing Address - Country:US
Mailing Address - Phone:714-556-7246
Mailing Address - Fax:714-556-7247
Practice Address - Street 1:2010 E 1ST ST STE 100
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4086
Practice Address - Country:US
Practice Address - Phone:714-556-7246
Practice Address - Fax:714-556-7247
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005139207X00000X, 363LA2100X
CA9500139363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner