Provider Demographics
NPI:1467693960
Name:FERNANDEZ, ANNA C (RN)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:C
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7067 E LYNX WAGON RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1938
Mailing Address - Country:US
Mailing Address - Phone:928-717-3276
Mailing Address - Fax:
Practice Address - Street 1:1845 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1211
Practice Address - Country:US
Practice Address - Phone:928-717-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN153026163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse