Provider Demographics
NPI:1497307557
Name:WAGNER, ANNA (FNP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:WAGNER
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 1:1140 BUSINESS CENTER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2741
Mailing Address - Country:US
Mailing Address - Phone:713-800-0660
Mailing Address - Fax:361-696-6060
Practice Address - Street 1:7121 S PADRE ISLAND DR STE 300
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4940
Practice Address - Country:US
Practice Address - Phone:361-696-6043
Practice Address - Fax:361-696-6020
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142098363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily