Provider Demographics
NPI:1942964218
Name:BLAZEK, ANA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:BLAZEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 W LULLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-4620
Mailing Address - Country:US
Mailing Address - Phone:870-476-1316
Mailing Address - Fax:
Practice Address - Street 1:8930 FOURWINDS DR STE 101
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78239-1971
Practice Address - Country:US
Practice Address - Phone:210-653-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-23
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1049968363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner