Provider Demographics
NPI:1710529151
Name:COMAYAGUA, ANNA M (APN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:COMAYAGUA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 CRAB APPLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08848-1803
Mailing Address - Country:US
Mailing Address - Phone:908-892-6607
Mailing Address - Fax:
Practice Address - Street 1:1101 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-4152
Practice Address - Country:US
Practice Address - Phone:484-544-3113
Practice Address - Fax:610-841-8457
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00970200363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1790396281OtherTITAN HEALTH GROUP NPI#