Provider Demographics
NPI:1295543981
Name:BACALLAO-CUMMINGS, ANA (FNP-C)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:BACALLAO-CUMMINGS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40114 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MS
Mailing Address - Zip Code:39746-9686
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40114 HAMILTON RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MS
Practice Address - Zip Code:39746-9686
Practice Address - Country:US
Practice Address - Phone:662-364-1708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907131363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily