Provider Demographics
NPI:1962838516
Name:SOLTERO, JANA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:
Last Name:SOLTERO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JANA
Other - Middle Name:
Other - Last Name:GAUNTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 740018
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0018
Mailing Address - Country:US
Mailing Address - Phone:773-352-1517
Mailing Address - Fax:312-929-0373
Practice Address - Street 1:4208 CENTRAL AVE SW STE G
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-1695
Practice Address - Country:US
Practice Address - Phone:505-777-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-15
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA-2013-0065363A00000X, 363AM0700X, 363AM0700X
WAPA60745874363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant