Provider Demographics
NPI:1346791761
Name:REMIGIO, ANA CAROLINE TELES (FNP)
Entity Type:Individual
Prefix:
First Name:ANA CAROLINE
Middle Name:TELES
Last Name:REMIGIO
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 1:264 N HIGHLAND SPRINGS AVE
Mailing Address - Street 2:# 4
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-3082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1003 E COOLEY DR
Practice Address - Street 2:SUITE 209
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3948
Practice Address - Country:US
Practice Address - Phone:909-528-3803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily