Provider Demographics
NPI:1821366469
Name:DIZON, ANNA LEE (ANP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LEE
Last Name:DIZON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S BICENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501
Mailing Address - Country:US
Mailing Address - Phone:956-971-0077
Mailing Address - Fax:956-971-0076
Practice Address - Street 1:500 S BICENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501
Practice Address - Country:US
Practice Address - Phone:956-971-0077
Practice Address - Fax:956-971-0076
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-10
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2932322363LA2200X
TX817036363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health