Provider Demographics
NPI:1013244243
Name:ANAYA, GERARDO (FNP)
Entity Type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:
Last Name:ANAYA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 N LEE TREVINO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4563
Mailing Address - Country:US
Mailing Address - Phone:915-590-9424
Mailing Address - Fax:915-590-9044
Practice Address - Street 1:1721 N LEE TREVINO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4563
Practice Address - Country:US
Practice Address - Phone:915-590-9424
Practice Address - Fax:915-590-9044
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP118409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX274054YLPSOtherWELLMED PTAN
TX315047604Medicaid