Provider Demographics
NPI:1386045540
Name:QUINTERO, ANA LISA (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANA LISA
Middle Name:
Last Name:QUINTERO
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 S VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3232
Mailing Address - Country:US
Mailing Address - Phone:956-787-5454
Mailing Address - Fax:956-787-5486
Practice Address - Street 1:1229 S VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3232
Practice Address - Country:US
Practice Address - Phone:956-787-5454
Practice Address - Fax:956-787-5486
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341017701Medicaid
TX376663YNG9Medicare PIN