Provider Demographics
NPI:1922342013
Name:GUTIERREZ, ANA MARGARITA (FNP)
Entity Type:Individual
Prefix:MS
First Name:ANA
Middle Name:MARGARITA
Last Name:GUTIERREZ
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 1:5929 BALCONES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4280
Mailing Address - Country:US
Mailing Address - Phone:512-689-4703
Mailing Address - Fax:877-647-0202
Practice Address - Street 1:2110 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8878
Practice Address - Country:US
Practice Address - Phone:928-344-2300
Practice Address - Fax:877-647-0202
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN095727363LF0000X
AZAP4776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ768580Medicaid
AZZ165576Medicare UPIN