Provider Demographics
NPI:1821651985
Name:BAENA, ALICIA IVANA (MSN, RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:IVANA
Last Name:BAENA
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:850 W RIO SALADO PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-3812
Mailing Address - Country:US
Mailing Address - Phone:602-926-0849
Mailing Address - Fax:
Practice Address - Street 1:13656 BRETON RIDGE ST # AH
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-6081
Practice Address - Country:US
Practice Address - Phone:281-429-8780
Practice Address - Fax:281-763-7930
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139889363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily